Practice Guideline Recommendations on Perioperative Fasting

Abstract

This article presents several high-level recommendations ready for immediate implementation, while poorly graded and inconsistent recommendations reveal key areas for future research. Meanwhile, guideline quality requires improvement, especially regarding rigor of development and applicability, through systematic methodology, reporting transparency, and implementation strategies.

ASPEN Safe Practices for Enteral Nutrition Therapy

“…The standard practice of NPO after midnight prior to procedures and surgery has been challenged and warrants patient‐specific consideration regarding its appropriateness and risks and benefits 79 . For example, jejunal feeding may not need to be held for the same time period as gastric feeding, especially when gastric decompression may be an option prior to a procedure.…”

The Perioperative Surgical Home and Enhanced Recovery After Surgery: Perspectives from Two Continents

“…Other clinical benefits include a 34% reduction in in-hospital mortality and 41% reduction in acute renal failure, demonstrated by one study infusing insulin to induce normoglycaemia in surgical ICU patients [25] . Both ER and the PSH promote minimal perioperative fasting and early recommencement of food [26] .…”

Peri‐operative nutrition

“…A reduction in the standard fasting periods has little to no effect on the volume or pH of gastric contents . A fast of 2 h for clear fluids is sufficient to ensure an empty stomach for the majority of otherwise well elective surgical patients, whereas no solid food should be consumed 6 h before anaesthetic induction . However, aspiration is uncommon – studies have not quantified the rate of aspiration or related morbidity associated with different fasting periods.…”

“…Recommendations are therefore based on the indirect measures of gastric volume and pH. Gastric emptying is slowed for patients with certain chronic illnesses or receiving specific therapies (Table ) . Standard fasting guidelines should not be applied uniformly for these populations, particularly as they have not been studied by the studies on which the recommendations have been based .…”

“…Earlier feeding is associated with reduced infectious complications , improved wound healing , resolution of ileus and reduced length of stay . Following an uncomplicated operation, patients should eat as soon as they can tolerate food, ideally within 24 h . The rate of successful feeding within 6–24 h of surgery ranges from 75% to 95%, with early initiation of feeding associated with improved feed tolerance .…”