PRE-OPERATIVE FASTING GUIDELINES

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PRE-OPERATIVE FASTING GUIDELINES

• ROYAL COLLEGE OF NURSING AND THE
• AMERICAN SOCIETY OF ANESTHESIOLOGISTS
• By Pamela Mair

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INTRODUCTION

• Guidelines provide recommendations for good
  practice, based upon the best available evidence
  of clinical effectiveness, and is intended to
  provide key source material for developing local
  guidelines (policy and procedures).
• The main areas examined by the guidelines
  are
• preoperative fasting in healthy adults
• preoperative fasting in healthy children
• Recommendations for good practice, based upon the
  best available evidence of clinical
  effectiveness, are presented. Recommendations
  contained in these guidelines are those
  considered to be central to pre-operative fasting
  care. This is a guide to that management, not a
  text book of care.
• Health care professionals should use their
  clinical judgement in support of these
  evidenced-based recommendations.

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Pre-op Fasting in Healthy Adults

• The intake of oral fluids. The volume of liquid
  ingested is less important than the type of
  liquid ingested.
• Intake of water up to 2 hrs before induction of
  anaesthesia.
• Other clear fluids , clear tea and coffee
  without milk up to 2 hrs before induction of
  anaesthesia.
• Tea and coffee with milk are acceptable up to 6
  hrs before induction of anaesthesia.
• The volume of administered fluids does not appear
  to have an impact on patients residual gastric
  volume and gastric pH, when compared to a
  standard fasting regimen. Therefore, patients may
  have unlimited amounts of water and other clear
  fluid up to two hours before induction of
  anaesthesia.
• In practice, a clear fluid is one through which
  newsprint can be read.
• Healthy defined as ASA I-II without
  gastrointestinal disease or disorders

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Pre-op Fasting in Healthy Adults

• The intake of solid foods
• A minimum pre-op fasting time of 6hrs is
  recommended for food (solids and milk).
• Fried or fatty meal 8hrs is recommended before
  induction of anaesthesia.
• Chewing gum and sweets
• Chewing gum should not be permitted on the day of
  surgery.
• Sweets are solid food. A minimum of 6hrs pre-op
  fasting time is recommended.

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Pre-op Fasting in High Risk Adults

• General Recommendations
• Higher-risk patients should follow the same pre
  op fasting regime as healthy adults, unless
  contraindicated. In addition, the anaesthetic
  team should consider further interventions, as
  appropriate to the overall clinical situation.
• Adults undergoing emergency surgery should be
  treated as if they have a full stomach. If
  possible, the patient should follow normal
  fasting guidance to allow gastric emptying.
• High risk of regurgitation and aspiration
  patients include those with obesity,
  gastro-oesophageal reflux and diabetes.

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Pre-op Fasting in Healthy Children

• The intake of oral fluids. The volume of liquid
  ingested is less important than the type.
• Intake of water and other clear fluids up to 2
  hrs before induction of anaesthesia.
• The intake of milk
• Breast milk may be given up to 4hrs before
  induction of anaesthesia.
• Formula milk or cows milk may be given up to
  6hrs before induction of anaesthesia.

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Pre-op Fasting in Healthy Children

• The intake of solid foods
• A minimum pre-op fasting time of 6hrs is
  recommended for food
• Chewing Gum and Sweets
• Chewing gum should not be permitted on the day of
  surgery.
• Sweets including lollipops are solid food. A
  minimum pre-op fasting time of six hours is
  recommended.

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Pre-op Fasting in HighRisk Children

• General recommendations
• Higher-risk patients should follow the same
  pre-op fasting regime as healthy children, unless
  contraindicated. In addition, the anaesthetic
  team should consider further interventions, as
  appropriate to the overall clinical situation.
• Children undergoing emergency surgery should be
  treated as if they have a full stomach. If
  possible, the child should follow normal fasting
  guidance to allow for gastric emptying.

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Summary of Fasting Recommendations

• Ingested Material Minimum Fasting Period
• Clear liquids 2hrs
• Breast Milk 4hrs
• Infant Formula 6hrs
• Non-human milk 6hrs
• Light meal 6hrs