[International multidisciplinary consensus statement on perioperative fasting in adults]

The aim of this consensus statement was to develop evidence-based recommendations on perioperative fasting, taking the growing global awareness of the negative effects of prolonged fasting before surgery into account, particularly with respect to clear liquids.

A systematic literature search was conducted, including assessments of the risk of bias and the overall level of evidence using GRADE methodology to develop 13 preliminary recommendations on perioperative fasting. This was followed by a 3-stage Delphi process involving an international, multidisciplinary panel of 68 experts and nonexperts. Experts on perioperative fasting were selected via a focused literature search, while nonexperts were selected via relevant organizations. The panel comprised anesthetists, surgeons, nurses, cardiologists, gastroenterologists, other physicians, patient representatives and members of international organizations related to the topic, including patient safety organizations and enhanced recovery after surgery (ERAS) societies.

The panel of 68 stakeholders subsequently agreed on 8 recommendations. These recommendations are intended for all healthcare professionals as guidance for perioperative fasting in adults undergoing sedation or anesthesia. The consensus statement supports current preoperative fasting practices for solid food and non-clear liquids, reflecting the lack of meaningful new evidence. Patients should fast for 6h with respect to non-clear liquids, including milk, milk products, meal replacement drinks and enteral feeding formulas. They should fast for at least 6h with respect to solid food; for large fatty meals fasting for 8h or longer may be necessary; however, with respect to clear liquids it reflects a fundamental shift towards more liberal liquid regimens. It is recommended that institutional protocols should be implemented to reduce liquid fasting times. These protocols can either encourage patients to drink clear liquids until 2 h before the start of anesthesia or sedation or permit the intake of clear liquids less than 2 h before the start of anesthesia or sedation within institutional protocols. Clear liquids include water, tea or coffee with sugar or honey (including a small amount of milk, up to one fifth of the total volume), clear juices, lemonade and clear carbohydrate drinks. The consensus statement further recommends that oral intake should be resumed as soon as clinically feasible and that preprocedural gastric ultrasound performed by a trained provider can be used to guide clinical decisions when additional information is required.

These consensus-based recommendations are not an official guideline issued by any national or international professional society. Nevertheless, they are currently regarded as the most comprehensive and up-to-date review of the available evidence, based on robust methodology. The broad international consensus suggests that the recommendations published in Die Anaesthesiologie provide a reliable basis to improve the quality of patient care by minimizing periprocedural fasting times, within safe margins. To achieve this, preoperative liberal clear liquid regimens can be implemented with institutional protocols.