Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration

Publication Date: January 15, 2023
Last Updated: January 18, 2023

Summary of Recommendations

We recommend healthy adultsa drink carbohydrate-containing clear liquids until 2 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation. The carbohydrates may be simple or complex. (S, M )
Up to 400 ml of clear liquids is considered an appropriate volume. Trial participants ingested a median of 400 ml of carbohydrate-containing clear liquids (interquartile range, 300 to 400 ml) up to 2 h before anesthesia administration.
a Individuals without coexisting diseases or conditions that may increase the risk for aspiration, including esophageal disorders such as significant uncontrolled reflux disease, hiatal hernia, Zenker’s diverticulum, achalasia, stricture, previous gastric surgery (for example, gastric bypass), gastroparesis, diabetes mellitus, opioid use, gastrointestinal obstruction or acute intraabdominal processes, pregnancy, obesity, and emergency procedures. Exercise clinical judgment with this patient population.
620
There is insufficient evidence to recommend protein-containing clear liquids preferentially over other clear liquids 2 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation (no recommendation). (, VL )
620
We suggest not delaying elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation in healthy adults who are chewing gum. (, VL )
Chewing gum should be removed before any sedative/anesthetic is administered.
620
There is insufficient evidence concerning benefits and harms to recommend pediatric patients drink clear liquids until 1 h versus 2 h before procedures with general anesthesia, regional anesthesia, or procedural sedation (no recommendation). (, VL )
620
To avoid prolonged fasting in children, efforts should be made to allow clear liquids in children at low risk of aspiration as close to 2 h before procedures as possible. In children with shorter clear liquid fasting duration, exercise clinical judgment. (Best Practice Statement) (U, U)
620

Recommendation Grading

Overview

Title

Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration

Authoring Organization

American Society of Anesthesiologists

Publication Month/Year

January 15, 2023

Last Updated Month/Year

December 11, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

These practice guidelines are a modular update of the "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." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.

Target Patient Population

Patients undergoing general anesthesia, regional anesthesia, or procedural sedation for elective procedures

Target Provider Population

Anesthesiologists and allied caregivers

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D011300 - Preoperative Care, D005215 - Fasting, D057234 - Preoperative Period

Keywords

Preoperative Fasting

Source Citation

Source Joshi GP, et al. 2024 American Society of Anesthesiologists Practice Guidelines 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; 138:132–51. DOI: 10.1097/ALN.0000000000004381

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: https://doi.org/10.1097/ ALN.0000000000001452

Methodology

Number of Source Documents
189
Literature Search Start Date
June 30, 2020
Literature Search End Date
November 30, 2021