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

Warner, Mark A.; Caplan, Robert A.; Epstein, Bernard S.; Gibbs, Charles P.; Keller, Candace E.; Leak, Jessie A.; Maltby, Roger; Nickinovich, David G.; Schreiner, Mark S.; Weinlander, Chris M.

doi:10.1097/00132586-200002000-00048

Cited by 30 publications

(37 citation statements)

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“…Recently, several national anaesthesia societies have revised their guidelines on preoperative fasting, recommending access to clear, non-particulate fluids up to 2 h prior to induction of anaesthesia [7][8][9][10]. These guidelines are supported by a Cochrane Collaboration review [2], The European Society for Parenteral and Enteral Nutrition [11], and the British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP) [12].…”

Section: Introductionmentioning

confidence: 99%

Reducing preoperative fasting in elective adult surgical patients: a case–control study

et al. 2011

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Section: Introductionmentioning

confidence: 99%

Reducing preoperative fasting in elective adult surgical patients: a case–control study

et al. 2011

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“…In the case of ingesting heavy meals, gastric emptying may be delayed and it is therefore recommended to prolong preoperative fasting [14]. As such, 8 h should be more than enough time for the passage of food from the stomach in patients with normal gastric motility.…”

Section: Discussionmentioning

confidence: 99%

Risk of aspiration during anesthesia in patients with congenital insensitivity to pain with anhidrosis: case reports and review of the literature

et al. 2010

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Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disease, characterized by episodes of unexplained fever, anhidrosis, pain insensitivity despite intact tactile perception, self-mutilating behavior, mental retardation, and autonomic nervous system (ANS) abnormalities. We present a case series of three patients with CIPA who underwent semielective orthopedic surgery under general anesthesia complicated by intraoperative regurgitation, and subsequent aspiration in two of the three cases. All three patients were nil per os (NPO) for at least 8 h prior to surgery. Two patients had their airways maintained with a laryngeal mask airway (LMA), and one patient had an endotracheal tube (ETT). The patients with an LMA suffered aspiration of gastric contents and subsequently developed hypoxic cardiac arrest. Although the patient with an ETT in situ regurgitated intraoperatively, the presence of the ETT prevented aspiration and any further potential complications. We review the perioperative complications typically observed in patients with CIPA and discuss the risks of using an LMA in these patients. We recommend that patients with CIPA always should be considered as having a "full stomach", regardless of the duration of their NPO status, due to their coexisting ANS abnormalities. Therefore, rapid-sequence induction with an ETT should be utilized for the anesthetic management in every patient with CIPA.

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“…Few laboratory tests are routinely performed in healthy children undergoing elective surgery, with the exception of pregnancy testing in menarchal women. The fasting guidelines, which are quite liberal and well enshrined in the ASA guidelines, are quite clear and unambiguous (5). However, how to handle a child who is chewing gum preoperatively was not addressed in the ASA guidelines and is not uni-formly handled by our colleagues.…”

Section: Preoperative Preparationmentioning

confidence: 99%

Anesthetizing children: little people, big problems!

Lerman¹

2012

AML

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". Our understanding of the etiology and pathogenesis of many of the "big problems" that children present may lead to better outcomes and better quality of care, and it is the quintessential proposition for the delivery of excellence in clinical care to these "little people". In this lecture we review a number of contentious and controversial issues that face pediatric anesthesiologists on a daily basis and present practical, evidence based approaches to addressing them.

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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

Cited by 30 publications

References 0 publications

Reducing preoperative fasting in elective adult surgical patients: a case–control study

Reducing preoperative fasting in elective adult surgical patients: a case–control study

Risk of aspiration during anesthesia in patients with congenital insensitivity to pain with anhidrosis: case reports and review of the literature

Anesthetizing children: little people, big problems!

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