Liberal liquid fasting and aspiration: a mandate for patient-centred precision care in perioperative fasting

Despite the recommendation for clear liquids up to 2 h before anaesthesia, the median liquid fasting time worldwide remains ∼12 h. If fasting times of <2 h for clear liquids were accepted, median liquid fasting times of 2-3 h could be achieved, but rigorous evidence synthesis on the incidence of perioperative aspiration is missing. Given that perioperative aspiration in elective patients is rare, definitive studies are practically impossible to conduct, which does not prove that aspiration risk is increased. Therefore, every aspiration event should be systematically evaluated before being attributed to the fasting strategy. Under these circumstances, it is high time that liberal liquid regimens individually assigned to each patient within institutional protocols are in line with recommendations by anaesthesia societies.