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Related Experiment Videos

Pre-procedural fasting in emergency sedation.

Rebecca J Thorpe1, Jonathan Benger

  • 1University Hospitals Bristol Foundation Trust, Bristol, UK. r.j.preece@doctors.org.uk

Emergency Medicine Journal : EMJ
|April 14, 2010
PubMed
Summary
This summary is machine-generated.

Routine pre-procedural fasting is not supported by evidence for emergency procedural sedation. The risk of pulmonary aspiration in non-fasted patients undergoing emergency sedation is low.

Related Experiment Videos

Area of Science:

  • Emergency Medicine
  • Anesthesiology
  • Critical Care

Background:

  • Emergency physicians often perform procedural sedation on non-fasted patients.
  • Current UK guidelines for pre-procedural fasting in emergency sedation are lacking.
  • North American Association of Anesthesiologists (ASA) guidelines for general anesthesia (GA) are often applied to emergency settings.

Purpose of the Study:

  • To evaluate the evidence regarding the risk of pulmonary aspiration during emergency procedural sedation in adults.
  • To determine if pre-procedural fasting is necessary for patients undergoing emergency procedural sedation.

Main Methods:

  • A systematic review of the literature was conducted.
  • Relevant articles were identified through abstract screening and hand-searching reference sections.
  • Papers were evaluated for relevance against pre-determined criteria.

Main Results:

  • The risk of aspiration during emergency procedural sedation is low.
  • No evidence supports routine pre-procedural fasting for emergency procedural sedation.
  • Large case series show non-fasted patients are not at increased risk of aspiration.
  • Only one case of aspiration was reported across 4657 adult and 17,672 pediatric cases.

Conclusions:

  • Routine fasting prior to procedural sedation in the Emergency Department is not recommended for most patients.
  • ASA guidelines for GA fasting lack robust evidence and are questionable for emergency sedation.
  • Selected high-risk patients may require individual risk:benefit assessment before sedation.