Are you thirsty?Fasting times in elective outpatient pediatric patients. The updated searches covered a 6.5-yr period from January 1, 2010, through May 31, 2016. Evidentiary information and recommendations regarding the administration of preoperative gastrointestinal stimulants and postoperative nausea and vomiting findings may be found in: Practice guidelines for postanesthetic care: An updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Girish P. Joshi, Basem B. Abdelmalak, Wade A. Weigel, Monica W. Harbell, Catherine I. Kuo, Sulpicio G. Soriano, Paul A. Stricker, Tommie Tipton, Mark D. Grant, Anne M. Marbella, Madhulika Agarkar, Jaime F. Blanck, Karen B. Domino; 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. All studied protein-containing clear liquids also contained carbohydrates. Select options. Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery. Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy. Only 2 of the trials randomized participants into 1- and 2-h fasting protocols; the remaining studies were not designed to compare 1- and 2-h fasting; however, they included results from pediatric patients fasted less than 2h. Most children were ASA Physical Status I or II, although one trial enrolling patients with cyanotic congenital heart disease were more likely of higher ASA Physical Status (ASA Physical Status not reported). Placebo-controlled RCTs indicate that orally-administered famotidine is effective in reducing gastric volume and acidity during the perioperative period (Category A2-B evidence).64,8991 One placebo-controlled RCT reports similar findings for intramuscular famotidine (Category A3-B evidence).92 The literature is insufficient to evaluate the effect of administering histamine-2 receptor antagonists on perioperative pulmonary aspiration or emesis/reflux. Premedication with cimetidine and metoclopramide. They provide basic recommendations for anesthesia care that are supported by synthesis and analysis of the current literature, expert and practitioner opinion, public comment, and clinical feasibility data. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. Titles with abstracts and full-text screening were performed using systematic review software (DistillerSR,9 Evidence Partners, Ottawa, Canada). The administration of preoperative anticholinergics to reduce the risk of pulmonary aspiration is not recommended. For the first time, the 2020 data include information on the flavors of the companies' smokeless tobacco products. Anesthesiology, V 126 No 3 376 March 2017: 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 Supplemental digital content is available for this article. 15 to 16, https://links.lww.com/ALN/C935) and thirst2342 compared with fasting patients (moderate strength of evidence). Eight hours fasting from enteral feeds is preferred. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperativelyA randomised clinical trial. Please refer to the table below. All protein-containing clear liquids in the trials included carbohydrates, precluding assessment of liquids containing only protein. Gastric fluid pH in patients receiving sodium citrate. The effect of oral intake during the immediate pre-colonoscopy time period on volume depletion in patients who receive sodium picosulfate. This document updates the Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: An Updated Report adopted by the ASA in 2010 and published in 2011.. Impact of clear fluid fasting on pulmonary aspiration in children undergoing general anesthesia: Results of the German prospective multicenter observational (NiKs) study. Both the consultants and ASA members disagree that gastrointestinal stimulants should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia in patients with no apparent increased risk for pulmonary aspiration. 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 Aspiration was not reported in any of the included studies (randomized controlled trials32,43,49,5255,64 or nonrandomized designs90). Previous ASA guidelines recommend that clear liquids such as water, black coffee, black tea, and juice without pulp are safe to drink until 2 h before general anesthesia, regional anesthesia, or procedural sedation for elective procedures. Fv 27, 2023 . Exclusion criteria (except to obtain new citations): For the systematic review, potentially relevant clinical studies were identified via electronic and manual searches of the literature. (Chair), Chicago, Illinois; Madhulika Agarkar, M.P.H., Schaumburg, Illinois; Richard T. Connis, Ph.D., Woodinville, Washington; Charles J. Cot, M.D., Boston, Massachusetts; David G. Nickinovich, Ph.D., Bellevue, Washington; and Mark A. Warner, M.D., Rochester, Minnesota. These studies were combined with 133 pre-2010 articles used in the previous update, resulting in a total of 175 articles found acceptable as evidence for these guidelines. Ranitidine and prevention of pulmonary aspiration syndrome. When significant heterogeneity was found among the studies (P< 0.01), DerSimonian-Laird random-effects odds ratios were obtained. NPO Guidelines Guidelines for Adults and Teenagers Adults and teenagers over the age of 12 may have solid foods and dairy products until 8 hours before their scheduled arrival time at the hospital or surgery center. Benefits, Harms, and Strength of Evidence for Chewing Gum versus Fasting. Going from evidence to recommendationsThe significance and presentation of recommendations. Anesthesiology 2013; 118:291307. Survey responses from active ASA members are reported in summary form in the text, with a complete listing of ASA member survey responses reported in appendix 2 (table 4). Gastric emptying for liquids of different compositions in children. Strona gwna / Uncategorized / asa npo guidelines 2020 chewing tobacco. The mean age of participants was 43.2 yr, and 64% were female. If I take food in through an enteral or nasogastric tube (e.g., gastric/stomach tube, enteral/jejunostomy tube, etc.) Comparison of the effects of famotidine and ranitidine on gastric secretion in patients undergoing elective surgery. Links to the digital files are provided in the HTML text of this article on the Journals Web site (www.anesthesiology.org). Aspiration pneumonitis and aspiration pneumonia. ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. Throughout these guidelines, the term preoperative should be considered synonymous with preprocedural, as the latter term is often used to describe procedures that are not considered to be operations. Assessing the effect of sugar-free chewing gum use on the residual gastric volume of patients fasting for gastroscopy: A randomised controlled trial. The impact and safety of preoperative oral or intravenous carbohydrate administration. (Chair). **, Strongly Agree: Median score of 5 (at least 50% of the responses are 5), Agree: Median score of 4 (at least 50% of the responses are 4 or 4 and 5), Equivocal: Median score of 3 (at least 50% of the responses are 3, or no other response category or combination of similar categories contain at least 50% of the responses), Disagree: Median score of 2 (at least 50% of responses are 2 or 1 and 2), Strongly Disagree: Median score of 1 (at least 50% of responses are 1). Effects of oral rehydration therapy on gastric volume and pH in patients with preanesthetic h2 antagonist. Inconsistent results were reported for residual gastric volume. Editorials, letters, and other articles without data were excluded. Benefits of fasting abbreviation with carbohydrates and omega-3 infusion during CABG: A double-blind controlled randomized trial. These liquids should not include alcohol. Prevention of perioperative pulmonary aspiration is part of the process of preoperative evaluation and preparation of the patient. Residual gastric volume evaluation with ultrasonography after ingestion of carbohydrate- or carbohydrate plus glutamine-enriched beverages: A randomized, crossover clinical trial with healthy volunteers. Decreased risk of dehydration or hypoglycemia from prolonged fasting. Preoperative magnesium trisilicate in infants. The body of evidence was first described according to study characteristics and treatment arms. Assuming a 1.1/10000 baseline incidence of aspiration to detect a 2-fold increase would require 214000 participants per arm in a two-arm study (power, 80%; , 0.05). Responses to atropine, glycopyrrolate, and riopan of gastric fluid pH and volume in adult patients. Chewing gum for 1h does not change gastric volume in healthy fasting subjects: A prospective observational study. Oral carbohydrate administration in patients undergoing cephalomedullary nailing for proximal femur fractures: An analysis of clinical outcomes and patient satisfaction. For studies that report statistical findings, the threshold for significance is P< 0.01. Table 7 summarizes the evidence for clinically important outcomes. Findings from the aggregated literature are reported in the text of the guidelines by evidence category, level, and direction and in appendix 2 (table 2). Level 1: The literature contains observational comparisons (e.g., cohort, case-control research designs) with comparative statistics between clinical interventions for a specified clinical outcome. Single-dose oral omeprazole for reduction of gastric residual acidity in adults for outpatient surgery. For pediatric patients undergoing elective procedures with general anesthesia, regional anesthesia, or procedural sedation, what are the benefits and harms of 1-h versus 2-h clear liquid fasting? Both the consultants and ASA members strongly agree that for otherwise healthy infants (< 2 yr of age), children (2 to 16 yr of age) and adults, fasting from the intake of clear liquids for 2 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. The study results were extracted into DistillerSR by a single methodologist and reviewed by a second methodologist for quality control. Both the consultants and ASA members strongly agree that fasting from the intake of a meal that includes fried or fatty foods for 8 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. Updated by the American Society of Anesthesiologists Committee on Standards and Practice Parameters: Jeffrey L. Apfelbaum, M.D. The consultants agree and the ASA members strongly agree that for otherwise healthy neonates (< 44 gestational weeks) and infants, fasting from the intake of breast milk for 4 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. Search terms consisted of the interventions indicated above guided by the appropriate inclusion/exclusion criteria as stated in the Focus section of these updated guidelines. Safe pre-operative fasting times after milk or clear fluid in children. The evidence suggests there is not a clinically meaningful increase in gastric volume after chewing gum. Effect of the preoperative administration of water on gastric volume and pH. The evidence in adults comparing noncaloric clear liquids with those containing protein was limited, with one to two studies reporting each outcome of interest (table 5). Simple carbohydrates included clear fruit juices or water with glucose or fructose added.
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