Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration

Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration

Anesthesiology. 2017;126(3):376-393. 

In This Article

Abstract and Introduction

Introduction

PRACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.

This document updates the "Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: An Updated Report" adopted by the ASA in 2010 and published in 2011.

†American Society of Anesthesiologists: Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: An updated report. ANESTHESIOLOGY 2011; 114:495–511

*The term "gastroesophageal reflux disease" refers to positional reflux and its consequent symptomology, rather than food intolerances (e.g., "tomatoes do not agree with me").
†Examples of clear liquids include, but are not limited to, water, and fruit juices without pulp, carbonated beverages, carbohydrate-rich nutritional drinks, clear tea, and black coffee.
‡The Task Force notes that intake of fried or fatty foods or meat may prolong gastric emptying time.
§These guidelines do not address the use of antiemetics during the extended postoperative period after upper airway protective reflexes are no longer impaired.

*Unless otherwise specified, outcomes for the listed interventions refer to the occurrence of pulmonary aspiration complications associated with aspiration, gastric contents, or nausea/vomiting.

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