Last updated January 18, 2023

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

Summary of Recommendations

We recommend healthy adults 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.
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

Publication Month/Year

January 16, 2023

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

Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, Kuo CI, Soriano SG, Stricker PA, Tipton T, Grant MD, Marbella AM, Agarkar M, Blanck JF, Domino KB. 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 Feb 1;138(2):132-151. doi: 10.1097/ALN.0000000000004381. PMID: 36629465.