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.