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Pre-operative fasting guidelines: an update.

E Søreide1, L I Eriksson, G Hirlekar

  • 1Department of Anaesthesia and Intensive Care, Stavanger University Hospital, Stavanger, Norway. soed@sir.no

Acta Anaesthesiologica Scandinavica
|August 13, 2005
PubMed
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New Scandinavian guidelines support liberal pre-operative fasting, allowing clear fluids up to 2 hours before anesthesia. Further research is needed for specific patient groups like those with diabetes or undergoing deep sedation.

Area of Science:

  • Anesthesiology
  • Gastroenterology
  • Evidence-based medicine

Background:

  • Current international guidelines recommend restricted pre-operative fasting, with clear fluids allowed up to 2 hours and light meals up to 6 hours before anesthesia.
  • Recent advancements include pre-operative oral nutrition with carbohydrate-rich beverages, shown to be safe regarding gastric volume and acidity.
  • These practices are generally extended to children and non-laboring pregnant women, with specific allowances for milk feeding in infants.

Framework:

  • New consensus-based Scandinavian guidelines for pre-operative fasting have been developed based on available literature.
  • The guidelines advocate for more liberal fasting routines compared to previous practices.

Implementation:

  • Clear fluids are generally permitted up to 2 hours before anesthesia.

Related Experiment Videos

  • Light meals are allowed up to 6 hours prior to anesthesia.
  • Specific recommendations exist for infants (<6 months), allowing breast or formula milk up to 4 hours before anesthesia.

    • Implications:

    • The guidelines address the need for further research into the application of liberal fasting in specific patient populations, including those with functional dyspepsia or diabetes mellitus.
    • Controversial areas requiring more investigation include fasting for emergency patients, women in labor, and procedures under deep sedation.
    • Additional research is essential to advance towards completely evidence-based pre-operative fasting guidelines.