Updated Guidelines Address Preoperative Fasting For Elective Procedures

The American Society of Anesthesiologists (ASA) has issued an updated set of guidelines with recommendations for patients undergoing elective procedures.¹ The initial set of guidelines was published in 2017, and this is the first update to that version.²

“The purpose of this modular update is to evaluate the current evidence on preoperative fasting, focusing on these interventions,” the authors wrote. “All other recommendations from the 2017 guideline still apply. The outcomes of interest for this update include the adverse consequences of fasting (hunger, thirst, and preoperative nausea and vomiting) and pulmonary aspiration.”

There are several topics that the new guidelines focus on that were not previously addressed in the original guidelines, such as, ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.

The 2023 guidelines reaffirm the ASA’s previous statement that carbohydrate-containing clear liquids are safe to drink 2 hours prior to an elective operation. This includes water, black coffee, black tea, and juice without pulp. Further, the guidelines state that, for patients with a low aspiration risk, patients prefer drinking carbohydrate-containing clear liquids over absolute fasting before a procedure.

The use of chewing gum is a common tactic by patients prior to an elective operation, the use of chewing gum was not recommended by the authors as there was not sufficient evidence to support any type of benefit. However, the authors note that if patients chew gum for personal comfort, for example, there is no need to delay the procedure. The authors stress that the patients should not have chewing gum in their mouth before any sedative or anesthetic is administered.

The authors reviewed evidence to find any benefits or harms of 1-hour vs 2-hour clear liquid fasting in pediatric patients who are undergoing elective procedures. To avoid prolonged fasting in children, the authors concluded that pediatric patients should be allowed to drink clear liquids as close to 2 hours before procedures.

Reference:

1. Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration—a modular update of the 2017 American Society of Anesthesiologists practice guidelines for preoperative fasting. Anesthesiology. 2023;138:132-151. doi:10.1097/ALN.0000000000004381
2. 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;376-393. doi:10.1097/ALN.0000000000001452