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Peri-operative fasting in adults: an international, multidisciplinary consensus statement
Anne Rüggeberg1, Kariem El-Boghdadly2, Federico Bilotta3
1Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany.
Anaesthesia
|February 9, 2026
Summary
Liberalizing pre-operative clear liquid intake until 2 hours before anesthesia can improve patient wellbeing. This updated guidance minimizes fasting times while maintaining safety, benefiting peri-operative care.
Area of Science:
- Anesthesiology
- Surgical Care
- Patient Safety
Background:
- Prolonged pre-operative fasting is linked to adverse patient outcomes, including reduced wellbeing and impaired physiological responses.
- Existing fasting guidelines may lead to unnecessarily long fasting periods, necessitating updated recommendations.
- Liberalization of fasting practices is a growing trend, requiring evidence-based guidance.
Purpose of the Study:
- To develop international, multidisciplinary recommendations for peri-operative fasting practices.
- To address the adverse effects of prolonged fasting by promoting updated guidelines.
- To enhance patient care through optimized fasting protocols.
Main Methods:
- Systematic literature review to identify key issues in peri-operative fasting.
- Development of 13 draft recommendations, refined through a three-round Delphi consensus process.
- Involvement of a diverse international stakeholder panel, including patients and healthcare professionals from five continents.
Main Results:
- Eight consensus recommendations on peri-operative fasting were established.
- Current practices for solid and non-clear liquid fasting should be maintained.
- Clear liquid intake is encouraged until 2 hours before anesthesia, with institutional protocols supporting more liberal intake.
Conclusions:
- International consensus supports minimizing peri-operative fasting times within safe limits.
- Liberalized clear liquid intake regimens, supported by institutional protocols, can improve patient care.
- Updated guidelines aim to enhance patient wellbeing and optimize peri-operative management.
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