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The evidence base behind modern fasting guidelines.

Pauline C Stuart1

  • 1Department of Anaesthesia, Glasgow Royal Infirmary, 84 Castle Street Glasgow G4 OSF, UK. pstuart@globalnet.co.uk

Best Practice & Research. Clinical Anaesthesiology
|November 4, 2006
PubMed
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Preoperative fasting guidelines for general anesthesia can be relaxed. Drinking clear fluids up to two hours before surgery does not negatively impact gastric volume or acidity, potentially improving patient comfort.

Area of Science:

  • Anesthesiology
  • Gastroenterology
  • Surgical Patient Care

Background:

  • Preoperative fasting is standard practice before general anesthesia to minimize aspiration risk.
  • Current fasting guidelines vary regarding duration and type of intake.
  • Evidence-based review is needed to optimize fasting protocols for patient safety and well-being.

Purpose of the Study:

  • To systematically review the impact of different preoperative fasting regimens on perioperative complications.
  • To evaluate the effect of fasting duration, type, and volume of intake on patient safety and wellbeing.
  • To assess intraoperative gastric volume and pH as indirect measures of aspiration risk.

Main Methods:

  • Systematic review of randomized controlled trials and observational studies.

Related Experiment Videos

  • Analysis of preoperative fasting protocols, including fluid intake timing and composition.
  • Assessment of perioperative outcomes, focusing on gastric content, acidity, and patient-reported comfort.

    • Main Results:

    • No evidence indicates that fluid intake up to 2 hours preoperatively affects gastric volumes or pH.
    • Fluid intake up to 90 minutes preoperatively showed no impact on gastric contents, though based on limited data.
    • Allowing patients to drink water preoperatively was associated with significantly lower gastric volumes.

    Conclusions:

    • Current evidence suggests that liberalizing clear fluid intake up to 2 hours before general anesthesia is safe.
    • Permitting water intake preoperatively may reduce gastric volumes, potentially enhancing patient comfort.
    • Clinicians should review and potentially adjust existing preoperative fasting policies based on this evidence.