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

Perform a review of pertinent medical records, a physical examination, and patient survey or interview as part of the preoperative evaluation.

• The history, examination, and interview should include assessment of ASA physical status, age, sex, type of surgery, and potential for difficult airway management as well as consideration of gastroesophageal reflux disease, dysphagia symptoms, other gastrointestinal motility and metabolic disorders (e.g., diabetes mellitus) that may increase the risk of regurgitation and pulmonary aspiration.

Inform patients of fasting requirements and the reasons for them sufficiently in advance of their procedures.

Verify patient compliance with fasting requirements at the time of their procedure.

When these fasting guidelines are not followed, compare the risks and benefits of proceeding, with consideration given to the amount and type of liquids or solids ingested.

Clear liquids may be ingested for up to 2 h before procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.

• These liquids should not include alcohol.

Breast milk may be ingested for up to 4 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.

A light meal or nonhuman milk may be ingested for up to 6 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.

• Additional fasting time (e.g., 8 or more hours) may be needed in cases of patient intake of fried foods, fatty foods, or meat.

Consider both the amount and type of foods ingested when determining an appropriate fasting period.

Since nonhuman milk is similar to solids in gastric emptying time, consider the amount ingested when determining an appropriate fasting period.

Gastrointestinal stimulants may be preoperatively administered to patients at increased risk of pulmonary aspiration.

Do not routinely administer preoperative gastrointestinal stimulants for the purpose of reducing the risk of pulmonary aspiration in patients with no apparent increased risk for pulmonary aspiration.

Medications that block gastric acid secretion may be preoperatively administered to patients at increased risk of pulmonary aspiration.

Do not routinely administer preoperative medications that block gastric acid secretion for the purpose of reducing the risk of pulmonary aspiration in patients with no apparent increased risk for pulmonary aspiration.

Antacids may be preoperatively administered to patients at increased risk of pulmonary aspiration.

• Only administer nonparticulate antacids.

Do not routinely administer preoperative antacids for the purpose of reducing the risk of pulmonary aspiration in patients with no apparent increased risk for pulmonary aspiration.

Antiemetics may be preoperatively administered to patients at increased risk of postoperative nausea and vomiting.

The routine preoperative administration of antiemetics to reduce the risk of nausea and vomiting is not recommended for patients with no apparent increased risk for pulmonary aspiration.

The administration of preoperative anticholinergics to reduce the risk of pulmonary aspiration is not recommended.

The routine administration of preoperative multiple agents is not recommended for patients with no apparent increased risk for pulmonary aspiration.