Last updated March 14, 2022

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

Summary of Recommendations

Preoperative Assessment

  • 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.

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Clear Liquids

  • 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.

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Breast Milk

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

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Solids and Nonhuman Milk

  • 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.

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Gastrointestinal Stimulants

  • 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.

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Pharmacologic Blockade of Gastric Acid Secretion

  • 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.

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Antacids

  • 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.

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Antiemetics

  • 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.

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Anticholinergics

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

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Multiple Agents

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

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Recommendation Grading

Overview

Title

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

Authoring Organization

Publication Month/Year

March 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Provide direction for clinical practice related to preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration and to reduce the severity of complications related to perioperative pulmonary aspiration.

Target Patient Population

Healthy patients of all ages undergoing elective procedures

Target Provider Population

Anesthesiologists

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Hospital, Outpatient

Intended Users

Medical assistant

Scope

Counseling, Assessment and screening, Prevention, Management

Diseases/Conditions (MeSH)

D053120 - Respiratory Aspiration

Keywords

Pulmonary Aspiration, Anesthesiology, Preoperative Fasting

Source Citation

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. 

Methodology

Number of Source Documents
107
Literature Search Start Date
January 1, 2010
Literature Search End Date
May 31, 2016