Preoperative Fasting: Difference between revisions

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Relevant Article Depot:

NPO

Guidelines:

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*

2023 Canadian Pediatric Anesthesia Society Statement on fasting for elective pediatric anesthesia

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

Reviewing "Nil Per Os" Guidance for Clear Fluids in Children Before Anesthesia: Survey of the Pediatric Anesthesia Leadership Council

Guideline on anaesthesia and sedation in breastfeeding women 2020

Preoperative fasting in children: review of existing guidelines and recent developments

The rationale for the recommendations of the European Paediatric Fasting Guideline: Improving paediatric anaesthesia and perioperative medicine

Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care

Impact of liberal preoperative clear fluid fasting regimens on the risk of pulmonary aspiration in children (EUROFAST): an international prospective cohort study

Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children: A Retrospective Analysis

UpToDate: Preoperative fasting in children and infants

Fluid Fasting in Children: Solid Science?

https://bjanaesthesia.org/article/S0007-0912(21)00111-2/fulltext

Canadian Pediatric Anesthesia Society statement on clear fluid fasting for elective pediatric anesthesia

https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2766011

From PAAD

Preoperative fasting in children

Canadian Pediatric Anesthesia Society statement on clear fluid fasting for elective pediatric anesthesia

Anesthesia & Breastfeeding: More Often Than Not, They Are Compatible

Ultrasound Insights into Neonatal Fasting: Get in the NP-Know

ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017

The thirst for improvement: ensuring shorter and safer pre-operative fasting times in children

Effect of a carbohydrate lollipop on the gastric volume of fasted pediatric patients

Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation

Acute Intraoperative Pulmonary Aspiration

Impact of liberal preoperative clear fluid fasting regimens on the risk of pulmonary aspiration in children (EUROFAST): an international prospective cohort study Comment

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 Mar;126(3):376-393.

Frykholm P, Disma N, Andersson H, Beck C, Bouvet L, Cercueil E, Elliott E, Hofmann J, Isserman R, Kaucane A, Kuhn F, de Queiroz Siqueira M, Rosen D, Rudolph D, Schmidt AR, Schmitz A, Stocki D, Sumpelmann R, Stricker PA, Thomas M, Veyckemans F, Afshari A. Preoperative fasting in children: guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol 2022; 39:4–25.

Disma N, Frykholm P, Cook-Sather SD, Lerman J. Pro-con debate: 1- vs. 2-hour fast for clear liquids before anesthesia in children. Anesth Anal 2021; 133:581-91.

Determining residual gastric volume in healthy children using ultrasound

Ultrasound Assessment of Gastric Fluid Volume in Children Scheduled for Elective Surgery After Clear Fluid Fasting for 1 Versus 2 Hours: A Randomized Controlled Trial

Joshi GP, Abdelmalak BB, Weigel WA, et al. 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. Feb 1 2023;138(2):132-151. doi:10.1097/aln.0000000000004381

Frykholm P, Disma N, Andersson H, et al. Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care. European journal of anaesthesiology. Jan 1 2022;39(1):4-25. doi:10.1097/eja.0000000000001599

Sarhan KA, Hasaneen H, Hasanin A, Mohammed H, Saleh R, Kamel A. Ultrasound Assessment of Gastric Fluid Volume in Children Scheduled for Elective Surgery After Clear Fluid Fasting for 1 Versus 2 Hours: A Randomized Controlled Trial. Anesthesia and analgesia. Apr 1 2023;136(4):711-718. doi:10.1213/ane.0000000000006157

Yaster M, Galinkin J, Schreiner M. An Introduction to the Ethical Design, Conduct, and Analysis of Pediatric Clinical Trials. In: Andropolous D, Gregory G, eds. Gregory's Pediatric Anesthesia. 6th ed. Wiley-Blackwell; 2020:56-74:chap 4.

Roberts RB, Shirley MA. Reducing the risk of acid aspiration during cesarean section. Anesthesia and analgesia. Nov-Dec 1974;53(6):859-68. doi:10.1213/00000539-197453060-00010

DM, Rocke DA, Brock-Utne JG, Marszalek A, Engelbrecht HE. Critical volume for pulmonary acid aspiration: reappraisal in a primate model. British journal of anaesthesia. Aug 1990;65(2):248-50. doi:10.1093/bja/65.2.248

Contrasting Perspectives of Anesthesiologists and Gastroenterologists on the Optimal Time Interval between Bowel Preparation and Endoscopic Sedation

Pre-Procedural Fasting Policies for Patients Receiving Tube Feeding: A National Survey

Incidence of adverse respiratory events after adjustment of clear fluid fasting recommendations to 1 h: a prospective, observational, multi-institutional cohort study

Perioperative Tube Feedings – Common Questions

Preoperative Renin-Angiotensin System Antagonists Intake and Blood Pressure Responses During Ambulatory Surgical Procedures: A Prospective Cohort Study

Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives

Sip Til Send

Staying the Two-Hour Course on Pediatric Fasting Before Elective Surgery

Kelly C, Walker R. Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice. Paediatr Anaesth.2015;25:36-43.18.

Warner MA, Warner ME, Warner DO, et al. Perioperative pulmonary aspiration in infants and children. Anesthes. 1999;90:66-71.

Preoperative fasting in paediatric anaesthesia: a movie with a predicable ending

Gastric emptying for liquids of different compositions in children

Gastric pH and residual volume after 1 and 2 h fasting time for clear fluids in children

GLP-1 agonists/analogs

Clinical Practice Recommendations regarding patients taking GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists prior to anaesthesia or sedation for surgical and endoscopic procedures

Association between glucagon-like peptide-1 receptor agonist use and peri-operative pulmonary aspiration: a systematic review and meta-analysis

Association between Glucagon-like Peptide-1 Receptor Agonists and Aspiration Pneumonia during Endoscopic Procedures

Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice

American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

Association between glucagon-like peptide-1 receptor agonists, residual gastric content, and bronchopulmonary aspiration after fasting: an ongoing systematic review and meta-analysis

Assessment of Gastric Content Using Gastric Ultrasound in Patients on Glucagon-Like Peptide-1 Receptor Agonists Before Anesthesia

Gastric Ultrasound

Ultrasound assessment of gastric volume in the fasted pediatric patient undergoing upper gastrointestinal endoscopy: development of a predictive model using endoscopically suctioned volumes

Relationship between residual gastric content and peri-operative semaglutide use assessed by gastric ultrasound: a prospective observational study

Ultrasound assessment of gastric volume in the fasted pediatric patient undergoing upper gastrointestinal endoscopy: development of a predictive model using endoscopically suctioned volumes

Pre-operative gastric ultrasound in patients at risk of pulmonary aspiration: a prospective observational cohort study

Editorial: Point-of-care gastric ultrasound: food for thought

Can we use ultrasound examination of gastric content as a diagnostic test in clinical anaesthesia?

Gastric ultrasound in patients receiving semaglutide: a prospective, multicentre, matched control study

@@ Line 1: / Line 1: @@
 {{Stub Notice}}
+NPO
 <b>Guidelines:</b>
@@ Line 9: / Line 10: @@
 [https://pubs.asahq.org/anesthesiology/article/126/3/376/19733/Practice-Guidelines-for-Preoperative-Fasting-and 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]
+[https://pubmed.ncbi.nlm.nih.gov/39773771/ Reviewing "Nil Per Os" Guidance for Clear Fluids in Children Before Anesthesia: Survey of the Pediatric Anesthesia Leadership Council]
 [https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15179 Guideline on anaesthesia and sedation in breastfeeding women 2020]
@@ Line 18: / Line 21: @@
 [https://pubmed.ncbi.nlm.nih.gov/34857683/ Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care]
+[https://www.bjanaesthesia.org/article/S0007-0912(25)00215-6/fulltext Impact of liberal preoperative clear fluid fasting regimens on the risk of pulmonary aspiration in children (EUROFAST): an international prospective cohort study]
 [https://pubs.asahq.org/anesthesiology/article/133/3/523/108227/Preoperative-Fluid-Fasting-Times-and-Postinduction Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children: A Retrospective Analysis]
@@ Line 23: / Line 27: @@
 [https://www.uptodate.com/contents/preoperative-fasting-in-children-and-infants?search=preoperative-fasting-in+children_and_infants&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1 UpToDate: Preoperative fasting in children and infants]
-https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2766509
+[https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2766509 Fluid Fasting in Children: Solid Science?]
 https://bjanaesthesia.org/article/S0007-0912(21)00111-2/fulltext
-https://link.springer.com/article/10.1007/s12630-019-01382-z
+[https://link.springer.com/article/10.1007/s12630-019-01382-z Canadian Pediatric Anesthesia Society statement on clear fluid fasting for elective pediatric anesthesia]
 https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2766011
@@ Line 34: / Line 38: @@
 [https://www.bjaed.org/article/S2058-5349(17)30168-3/fulltext Preoperative fasting in children]
 [https://link.springer.com/content/pdf/10.1007/s12630-019-01382-z.pdf Canadian Pediatric Anesthesia Society statement on clear fluid fasting for elective pediatric anesthesia]
 [https://pubs.asahq.org/anesthesiology/article/127/4/A15/19790/Anesthesia-amp-Breastfeeding-More-Often-Than-Not Anesthesia & Breastfeeding: More Often Than Not, They Are Compatible]
@@ Line 52: / Line 54: @@
 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517287/ Acute Intraoperative Pulmonary Aspiration]
+[https://pubmed.ncbi.nlm.nih.gov/40410101/ Impact of liberal preoperative clear fluid fasting regimens on the risk of pulmonary aspiration in children (EUROFAST): an international prospective cohort study ] [https://pubmed.ncbi.nlm.nih.gov/40818914/ Comment]
 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 Mar;126(3):376-393.
@@ Line 63: / Line 67: @@
 [https://pubmed.ncbi.nlm.nih.gov/35881513/ Ultrasound Assessment of Gastric Fluid Volume in Children Scheduled for Elective Surgery After Clear Fluid Fasting for 1 Versus 2 Hours: A Randomized Controlled Trial]
-.           Joshi GP, Abdelmalak BB, Weigel WA, et al. 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. Feb 1 2023;138(2):132-151. doi:10.1097/aln.0000000000004381
+Joshi GP, Abdelmalak BB, Weigel WA, et al. 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. Feb 1 2023;138(2):132-151. doi:10.1097/aln.0000000000004381
-.           Frykholm P, Disma N, Andersson H, et al. Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care. European journal of anaesthesiology. Jan 1 2022;39(1):4-25. doi:10.1097/eja.0000000000001599
+Frykholm P, Disma N, Andersson H, et al. Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care. European journal of anaesthesiology. Jan 1 2022;39(1):4-25. doi:10.1097/eja.0000000000001599
-.           Sarhan KA, Hasaneen H, Hasanin A, Mohammed H, Saleh R, Kamel A. Ultrasound Assessment of Gastric Fluid Volume in Children Scheduled for Elective Surgery After Clear Fluid Fasting for 1 Versus 2 Hours: A Randomized Controlled Trial. Anesthesia and analgesia. Apr 1 2023;136(4):711-718. doi:10.1213/ane.0000000000006157
+Sarhan KA, Hasaneen H, Hasanin A, Mohammed H, Saleh R, Kamel A. Ultrasound Assessment of Gastric Fluid Volume in Children Scheduled for Elective Surgery After Clear Fluid Fasting for 1 Versus 2 Hours: A Randomized Controlled Trial. Anesthesia and analgesia. Apr 1 2023;136(4):711-718. doi:10.1213/ane.0000000000006157
-.           Yaster M, Galinkin J, Schreiner M. An Introduction to the Ethical Design, Conduct, and Analysis of Pediatric Clinical Trials. In: Andropolous D, Gregory G, eds. Gregory's Pediatric Anesthesia. 6th ed. Wiley-Blackwell; 2020:56-74:chap 4.
+Yaster M, Galinkin J, Schreiner M. An Introduction to the Ethical Design, Conduct, and Analysis of Pediatric Clinical Trials. In: Andropolous D, Gregory G, eds. Gregory's Pediatric Anesthesia. 6th ed. Wiley-Blackwell; 2020:56-74:chap 4.
-.           Schmitz A, Schmidt AR. Can we use ultrasound examination of gastric content as a diagnostic test in clinical anaesthesia? Pediatric Anesthesia. 2019;29(2):112-113. doi:https://doi.org/10.1111/pan.13555
+Roberts RB, Shirley MA. Reducing the risk of acid aspiration during cesarean section. Anesthesia and analgesia. Nov-Dec 1974;53(6):859-68. doi:10.1213/00000539-197453060-00010
-.           Roberts RB, Shirley MA. Reducing the risk of acid aspiration during cesarean section. Anesthesia and analgesia. Nov-Dec 1974;53(6):859-68. doi:10.1213/00000539-197453060-00010
+DM, Rocke DA, Brock-Utne JG, Marszalek A, Engelbrecht HE. Critical volume for pulmonary acid aspiration: reappraisal in a primate model. British journal of anaesthesia. Aug 1990;65(2):248-50. doi:10.1093/bja/65.2.248
-.           Raidoo DM, Rocke DA, Brock-Utne JG, Marszalek A, Engelbrecht HE. Critical volume for pulmonary acid aspiration: reappraisal in a primate model. British journal of anaesthesia. Aug 1990;65(2):248-50. doi:10.1093/bja/65.2.248
+[https://www.hindawi.com/journals/grp/2015/497176/ Contrasting Perspectives of Anesthesiologists and Gastroenterologists on the Optimal Time Interval between Bowel Preparation and Endoscopic Sedation]
+[https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2556 Pre-Procedural Fasting Policies for Patients Receiving Tube Feeding: A National Survey]
+[https://www.bjanaesthesia.org/article/S0007-0912(23)00563-9/fulltext Incidence of adverse respiratory events after adjustment of clear fluid fasting recommendations to 1 h: a prospective, observational, multi-institutional cohort study]
+[https://pubs.asahq.org/monitor/article/88/4/19/139952/Perioperative-Tube-Feedings-Common-Questions Perioperative Tube Feedings – Common Questions]
+[https://journals.lww.com/anesthesia-analgesia/fulltext/2024/04000/preoperative_renin_angiotensin_system_antagonists.12.aspx Preoperative Renin-Angiotensin System Antagonists Intake and Blood Pressure Responses During Ambulatory Surgical Procedures: A Prospective Cohort Study]
+[https://www.bjaopen.org/article/S2772-6096(24)00026-1/fulltext Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives]
+[https://aci.health.nsw.gov.au/networks/anaesthesia-perioperative-care/resources/sip-til-send Sip Til Send]
+[https://journals.lww.com/monitor/fulltext/2025/03000/staying_the_two_hour_course_on_pediatric_fasting.18.aspx Staying the Two-Hour Course on Pediatric Fasting Before Elective Surgery]
+Kelly C, Walker R. Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice. Paediatr Anaesth.2015;25:36-43.18.
+Warner MA, Warner ME, Warner DO, et al. Perioperative pulmonary aspiration in infants and children. Anesthes. 1999;90:66-71.
+[https://www.bjanaesthesia.org/article/S0007-0912(25)00223-5/fulltext Preoperative fasting in paediatric anaesthesia: a movie with a predicable ending]
+[https://pubmed.ncbi.nlm.nih.gov/29077812/ Gastric emptying for liquids of different compositions in children]
+[https://academic.oup.com/bja/article-abstract/114/3/477/263029 Gastric pH and residual volume after 1 and 2 h fasting time for clear fluids in children]
+<b>GLP-1 agonists/analogs</b>
+[https://www.anzca.edu.au/getContentAsset/0f35028e-e371-4220-a49a-ddee877051c8/80feb437-d24d-46b8-a858-4a2a28b9b970/Periprocedural-GLP-1-use-consensus-clinical-guide_P2.pdf Clinical Practice Recommendations regarding patients taking GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists prior to anaesthesia or sedation for surgical and endoscopic procedures]
+[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16601 Association between glucagon-like peptide-1 receptor agonist use and peri-operative pulmonary aspiration: a systematic review and meta-analysis]
+[https://pubs.asahq.org/anesthesiology/article/doi/10.1097/ALN.0000000000005174/141932/Association-between-Glucagon-Like-Peptide-1 Association between Glucagon-like Peptide-1 Receptor Agonists and Aspiration Pneumonia during Endoscopic Procedures]
+[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16306 Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice]
 [https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists]
-[https://www.hindawi.com/journals/grp/2015/497176/ Contrasting Perspectives of Anesthesiologists and Gastroenterologists on the Optimal Time Interval between Bowel Preparation and Endoscopic Sedation]
+[https://auckland.figshare.com/articles/preprint/Association_between_glucagon-like_peptide-1_receptor_agonists_residual_gastric_content_and_bronchopulmonary_aspiration_after_fasting_an_ongoing_systematic_review_and_meta-analysis/28537307?file=62206637 Association between glucagon-like peptide-1 receptor agonists, residual gastric content, and bronchopulmonary aspiration after fasting: an ongoing systematic review and meta-analysis]
+[https://journals.lww.com/anesthesia-analgesia/abstract/2026/04000/assessment_of_gastric_content_using_gastric.6.aspx Assessment of Gastric Content Using Gastric Ultrasound in Patients on Glucagon-Like Peptide-1 Receptor Agonists Before Anesthesia]
+<b>Gastric Ultrasound</b>
+[https://pubmed.ncbi.nlm.nih.gov/25495405/ Ultrasound assessment of gastric volume in the fasted pediatric patient undergoing upper gastrointestinal endoscopy: development of a predictive model using endoscopically suctioned volumes]
-[https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2556 Pre-Procedural Fasting Policies for Patients Receiving Tube Feeding: A National Survey]
+[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16454 Relationship between residual gastric content and peri-operative semaglutide use assessed by gastric ultrasound: a prospective observational study]
-[https://www.bjanaesthesia.org/article/S0007-0912(23)00563-9/fulltext Incidence of adverse respiratory events after adjustment of clear fluid fasting recommendations to 1 h: a prospective, observational, multi-institutional cohort study]
+[https://pubmed.ncbi.nlm.nih.gov/25495405/ Ultrasound assessment of gastric volume in the fasted pediatric patient undergoing upper gastrointestinal endoscopy: development of a predictive model using endoscopically suctioned volumes]
 [https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16117 Pre-operative gastric ultrasound in patients at risk of pulmonary aspiration: a prospective observational cohort study]
 [https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.16190 Editorial: Point-of-care gastric ultrasound: food for thought]
+[https://onlinelibrary.wiley.com/doi/10.1111/pan.13555 Can we use ultrasound examination of gastric content as a diagnostic test in clinical anaesthesia?]
+[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.70129 Gastric ultrasound in patients receiving semaglutide: a prospective, multicentre, matched control study]