Guidelines on preoperative fasting from the American Society of Anesthesiologists do not explicitly address gum chewing. Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia. A study of preoperative fasting in infants aged less than three months. The effects on gastric emptying and carbohydrate loading of an oral nutritional supplement and an oral rehydration solution: A crossover study with magnetic resonance imaging. Fasting duration is often substantially longer than recommended and prolonged fasting has well described adverse consequences. We further suggest not to delay surgery in healthy adults after confirming removal of chewed gum. Menthol chewing gum on preoperative thirst management: Randomized clinical trial. Select options. The influence of oral carbohydrate solution intake on stress response before total hip replacement surgery during epidural and general anaesthesia. Many types of smokeless tobacco products are used around the world. appropriate fasting period. Differences in regurgitation43,49,55,68 or preoperative vomiting52 were unobserved in randomized controlled trials (very low strength of evidence). All opinion-based evidence (e.g., survey data, open forum testimony, internet-based comments, letters, and editorials) relevant to each topic was considered in the development of these updated guidelines. Search for other works by this author on: Address correspondence to American Society of Anesthesiologists: 1061 American Lane, Schaumburg, Illinois 60173. Chewing gum was allowed either until induction or 30min to 1h before surgery. A comparative evaluation of cimetidine and sodium citrate to decrease gastric acidity: effectiveness at the time of induction of anaesthesia. The previous update was developed by an ASA-appointed Task Force of ten members, including anesthesiologists in both private and academic practice from various geographic areas of the United States and consulting methodologists from the ASA Committee on Standards and Practice Parameters. Additional fasting time (e.g., 8 or more hours) may be needed in cases of patient intake of fried foods, fatty foods, or meat. Since nonhuman milk is similar to solids in gastric emptying time, consider the amount ingested when determining an appropriate fasting period. Lansoprazole in the prophylaxis of acid aspiration during elective surgery. What is the manner of gastric emptying after ingestion of liquids with differences in the volume under uniform glucose-based energy content? Case reports and case series, conference abstracts, letters not considered research reports, non-English publications, and animal studies were excluded. Preoperative fasting in children: An audit and its implications in a tertiary care hospital. rdr2 special miracle tonic pamphlet location; scholastic scope finding and using text evidence answer key; prayer to bless bread and wine for communion Histamine-2 receptor antagonists: Meta-analysis of blinded placebo-controlled RCTs indicate that orally-administered ranitidine is effective in reducing gastric volume and acidity; the frequency of gastric volume > 25mL; the frequency of gastric pH levels < 2.5; and the risk of aspiration (i.e., gastric volume > 25mL and pH < 2.5) during the perioperative period (Category A1-B evidence).56,6170 Placebo-controlled RCTs of intravenous ranitidine report similar results for gastric pH (Category A2-B evidence) and equivocal findings for gastric volume (Category A2-E evidence).66,7174, Meta-analysis of placebo-controlled RCTs indicate that orally-administered cimetidine is effective in reducing gastric volume and acidity; the frequency of gastric volume > 25mL; the frequency of gastric pH levels < 2.5; and the risk of aspiration (i.e., gastric volume > 25mL and pH < 2.5) during the perioperative period (Category A1-B evidence).58,59,66,7587 Placebo-controlled RCTs of intravenous cimetidine report similar results for gastric pH (Category A2-B evidence), but equivocal findings for gastric volume (Category A2-E evidence).60,66,71,78,88. Safe pre-operative fasting times after milk or clear fluid in children. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Although controlled studies do not sufficiently evaluate such relationships, the reported evidence does focus on intermediate outcomes, including gastric contents (e.g., volume or pH) and nausea and vomiting, typically considered by the authors to be representative of a predicted risk of pulmonary aspiration. Effects of preoperative carbohydrate drinks on postoperative outcome after colorectal surgery. Gastric emptying of three liquid oral preoperative metabolic preconditioning regimens measured by magnetic resonance imaging in healthy adult volunteers: A randomised double-blind, crossover study. This is a modular update of the 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. Effects of preoperative oral carbohydrates on quality of recovery in laparoscopic cholecystectomy: A randomized, double blind, placebo-controlled trial. For adults undergoing elective procedures with general anesthesia, regional anesthesia, or procedural sedation, what are the benefits and harms of protein-containing clear liquids 2h before the procedure compared with fasting and other clear liquids? The mean age of participants was 43.2 yr, and 64% were female. chewing tobacco npo guidelines. A carbohydrate-rich beverage prior to surgery prevents surgery-induced immunodepression: A randomized, controlled, clinical trial. Comparative trial of the effect of ranitidine and cimetidine on gastric secretion in fasting patients at induction of anaesthesia. Differences were not detected in patient-rated or rates of hunger,32,43 thirst,32,43 or preoperative nausea32,43 (all very low strength of evidence). should I observe the same fasting intervals? Preoperative carbohydrate loading with individualized supplemental insulin in diabetic patients undergoing gastrointestinal surgery: A randomized trial. Complications of aspiration include, but are not limited to, aspiration pneumonia, respiratory compromise, and related morbidities. Evaluation of effects of a preoperative 2-hour fast with glutamine and carbohydrate rich drink on insulin resistance in maxillofacial surgery. Although the literature is insufficient to evaluate the influence of preoperatively adding milk or milk products to clear liquids (e.g., tea or coffee) on either pulmonary aspiration, gastric volume, pH, or gastric emptying, some studies with healthy volunteer subjects have reported equivocal findings for gastric volume and gastric emptying when these products are added to clear liquids.5254. I can't imagine chewing tobacco particles in the lungs would go over well. The effects of intravenous cimetidine and metoclopramide on gastric pH and volume in outpatients. The body of evidence included 22 adult surgical studies (20 randomized controlled trials,32,43,49,5255,57,64,68,73,76,80,85,91,148152 1 nonrandomized trial,90 and 1 retrospective cohort165), 7 adult nonsurgical studies (1 randomized controlled trial167 and 6 crossover studies170,171,173176), and 1 pediatric nonsurgical study104 comparing the effects of drinking protein-containing clear liquids with fasting or noncaloric clear liquids. 1 For patients undergoing elective procedures, this update addresses: American Society of Anesthesia Definitions of Types of Sedation: General Concepts The primary options a patient has for intravenous (IV) sedation during gastroenterological procedures include: Mild Sedation and Moderate Sedation Breathing takes place independently The patient remains responsive to stimuli Reduction of the risk of acid pulmonary aspiration in anaesthetized patients after cimetidine premedication. Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients. Meta-analyses from other sources are reviewed but not included as evidence in this document. 541-301-8460 asa npo guidelines 2020 chewing tobacco Licensed and Insured asa npo guidelines 2020 chewing tobacco Serving Medford, Jacksonville and beyond! colonel frank o'sullivan interview; beverly hills high school football The consultants agree and the ASA members strongly agree that fasting from the intake of a light meal (e.g., toast and a clear liquid) of 6 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. Studies with multicomponent interventions (for example, enhanced recovery after surgery protocols) were excluded if the effect of fasting on outcomes could not be independently ascertained. Smokeless tobacco causes cancer of the mouth, esophagus, and pancreas. The effect of preoperative oral fluid and ranitidine on gastric fluid volume and pH. Preoperative glycopyrrolate: oral, intramuscular, or intravenous administration. Effect of preoperative feeding on gastric emptying following spinal anesthesia: A randomized controlled trial. Identification of patients at increased risk of pulmonary aspiration (e.g., obesity, diabetes, smoking history): Medical records review (focused history). A light meal or nonhuman milk may be ingested for up to 6 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 2023; 138:132151 doi: https://doi.org/10.1097/ALN.0000000000004381. asa npo guidelines 2020 chewing tobacco asa npo guidelines 2020 chewing tobacco vo 9 Thng Su, 2022 vo 9 Thng Su, 2022 chewing tobacco npo guidelines Statement on Surgical Attire (Amended October 26, 2022) Statement on the Aging Anesthesiologist. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. 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 Systematic Review Protocol, https://links.lww.com/ALN/C930, PRISMA flowchart, https://links.lww.com/ALN/C931, Search strategy, https://links.lww.com/ALN/C932, Excluded studies bibliography with reasoning, https://links.lww.com/ALN/C933, Supplemental tables, https://links.lww.com/ALN/C934, Supplemental figures, https://links.lww.com/ALN/C935, Methods Supplement, https://links.lww.com/ALN/C962. Small study effects and the potential for publication bias were evaluated using funnel plots and regression-based tests.12 Analyses were conducted in R (R Foundation for Statistical Computing, Vienna, Austria).1315 (See the methods supplement for further details, https://links.lww.com/ALN/C962.). Anesthesiology 2013; 118:291307. Benefits, Harms, and Strength of Evidence for 1-h versus 2-h Clear Liquid Fasting in Children. A light meal or nonhuman milk may be ingested for up to 6 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.. Key Points. The authors declare no competing interests. In the U.S., the most popular include chewing tobacco, snuff, snus and dissolvable tobacco . Meta-analysis of placebo-controlled RCTs indicate that metoclopramide is effective in reducing gastric volume and pH during the perioperative period (Category A1-B evidence).5560 The literature is insufficient to evaluate the effect of metoclopramide on the perioperative incidence of pulmonary aspiration.***. Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: A pilot study. Society for Ambulatory Anesthesia 12th Annual Meeting, Orlando, Florida, 1997. The consultants and ASA members both disagree that preoperative antacids 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. Advise patients at every office visit to avoid exposure to environmental tobacco smoke at home, work, and in public places. Insufficient Literature. Pre-operative oral carbohydrate treatment before coronary artery bypass surgery. Proton pump inhibitors: Meta-analysis of placebo-controlled RCTs indicate that omeprazole is effective in reducing gastric volume and acidity (Category A1-B evidence).63,67,9395 RCTs report similar findings for lansoprazole (Category A2-B evidence),67,68,96,97 pantoprazole (Category A2-B evidence),63,73,98 and rabeprazole (Category A3-B evidence).68 The literature is insufficient to evaluate the effect of administering proton pump inhibitors on perioperative pulmonary aspiration or emesis/reflux. Approved by the ASA House of Delegates on October 26, 2016. Comparison of the Effect of Pre-operative Single Oral Dose of Tramadol and Famotidine on Gastric Secretions pH and Volume in Patients Scheduled for Laparoscopic Cholecystectomy. Patients with conditions that can affect gastric emptying or fluid volume. ASA members disagree and the consultants strongly disagree that proton pump inhibitors 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. Interindividual and intraindividual variability of fasted state gastric fluid volume and gastric emptying of water. 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. Authors: Amit Rastogi Sanjay Gandhi Post Graduate Institute of Medical Sciences Discover the world's research Content uploaded by. Twelve studies (53%) reported enrolling patients rated with ASA Physical Status I or II (2 studies also included ASA Physical Status III, and 9 did not report ASA Physical Status). One randomized controlled trial comparing 2 h fasting with fasting from midnight reported equivocal findings for blood glucose and insulin values (Category A3-E evidence).43. That's a GOOD thing. Aspiration of gastric contents is associated with increased perioperative morbidity and mortality [ 1-3 ], with highest risk associated with high volume, acidic, or particulate aspiration. The effect of a new preoperative fasting regime on the subjective perception, postoperative recovery, postoperative complications, and satisfaction in pediatric patients. In the carbohydrate arms, liquids were allowed an average of 2.25h before surgery (80% until 2h). 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. Excluded studies with reasoning are shown in the Supplemental Digital Content (https://links.lww.com/ALN/C933). 1 Clear liquids include water, tea, black coffee, pulp-free juice, and carbohydrate-rich drinks. Patient positioning such that a magnet cannot be used (prone, lateral, severe obesity, etc.). 18 to 20, https://links.lww.com/ALN/C935, and supplemental tables 5 and 6, https://links.lww.com/ALN/C934). When available, Category A evidence is given precedence over Category B evidence for any particular outcome. Comprehensive bibliographic database searches were conducted by a medical librarian using PubMed, EMBASE, and SCOPUS in July 2020 and updated in December 2021. Retrospective comparative studies (e.g., case-control). A carbohydrate-rich drink shortly before surgery affected IGF-I bioavailability after a total hip replacement. The administration of preoperative anticholinergics to reduce the risk of pulmonary aspiration is not recommended. Accepted for publication August 30, 2022. A randomised controlled study of preoperative oral carbohydrate loading. For adults, clear liquids between 2 and 4 h versus more than 4 h, For children, clear liquids between 2 and 4 h versus more than 4 h, Breast milk between 2 and 4 h versus more than 4 h, Formula between 2 and 4 h versus more than 4 h, Solids less than 4 h versus more than 4 h, Solids between 4 and 8 h versus more than 8 h. Preoperative pharmacologic interventions: Other H2 receptor antagonists (e.g., roxatidin, nazatidine, gastrozepin), Other proton pump inhibitors (e.g., pantoprazole, rabeprazole). A carbohydrate-rich beverage prior to surgery prevents surgery-induced immunodepression: a randomized, controlled, clinical trial. 8,827. 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. NPO Guidelines 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. The literature relating to seven evidence linkages contained enough studies with well-defined experimental designs and statistical information to conduct formal meta-analyses. Level 1: The literature contains a sufficient number of RCTs to conduct meta-analysis, and meta-analytic findings from these aggregated studies are reported as evidence. Effects of single-dose oral ranitidine and sodium citrate on gastric pH during and after general anaesthesia. Clinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft surgery. For patients undergoing elective procedures, this update addresses: Carbohydrate-containing clear liquids (simple or complex), Clear liquid fasting duration (1h vs. 2h) for children. In this framework, randomized control trials start as high strength of evidence, and nonrandomized studies start as low. Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Chewing gum, sucking hard candy on the morning of surgery may stimulate . Effect of pre-operative oral carbohydrate loading on recovery after day-case cholecystectomy: A randomised controlled trial. The PRISMA flow diagram (https://links.lww.com/ALN/C931) and Literature Search Strategy (https://links.lww.com/ALN/C932) are available as Supplemental Digital Content. Perioperative pulmonary aspiration is defined as aspiration of gastric contents occurring after induction of anesthesia, during a procedure, or in the immediate postoperative period. The body of evidence included 10 studies (7 randomized controlled trials,9297,187 1 crossover study,98 1 single-arm study,188 and 1 case series189) comparing chewing gum (sugar-free or sugared) with fasting, water, or lollipops. Pre-operative carbohydrate loading prior to elective caesarean delivery: A randomised controlled trial. Tolerance of, and metabolic effects of, preoperative oral carbohydrate administration in childrena preliminary report. Home glucometer readings may help guide the patients choice of a carbohydrate or a noncaloric clear liquid. anyone else have different thoughts? Infant formula may be ingested for up to 6 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia. Cochrane Bias Methods Group, Cochrane Statistical Methods Group. Address correspondence to the American Society of Anesthesiologists: 1061 American Lane, Schaumburg, Illinois 60173. Placebo-controlled RCTs are equivocal regarding the efficacy of glycopyrrolate to reduce gastric volume or acidity (Category A2-E evidence),83,102 and two nonrandomized placebo-controlled comparative studies report equivocal findings the efficacy of atropine on gastric volume and acidity (Category B1-E evidence).103,104. The strength of evidence was rated by outcome using the Grading of Recommendations, Assessment, Development, and Evaluation framework (table 1). Tobacco's calories (if there's any) is insignificant to interrupt weight loss. Lansoprazole reduces preoperative gastric fluid acidity and volume in children. The outcomes of interest for this update include the adverse consequences of fasting (hunger, thirst, and preoperative nausea and vomiting) and pulmonary aspiration. Emergency Laparotomy Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS) Society Recommendations Part I: Preoperative and intraoperative management Cytoreductive Gastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: An observational study. Level 2: The literature contains noncomparative observational studies with associative statistics (e.g., relative risk, correlation, sensitivity and specificity). Ultrasound assessment of gastric emptying time after intake of clear fluids in children scheduled for general anesthesia: A prospective observational study. The mean age of participants was 47 yr, 70% were female, and the average body mass index was 23.9kg/m2. Does preoperative oral carbohydrate reduce hospital stay? Cimetidine for prophylaxis of aspiration pneumonitis: comparison of intramuscular and oral dosage schedules. 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. Effect on the risk factors of acid aspiration. Medications that block gastric acid secretion may be preoperatively administered to patients at increased risk of pulmonary aspiration. Anesthesia care during procedures refers to general anesthesia, regional anesthesia, or procedural sedation and analgesia. 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). Trial comparator liquids such as water, placebo, broth, black tea, and black coffee are referred to as noncaloric clear liquids.. 1 Smokeless Tobacco and Oral Disease Smokeless tobacco can cause white or gray patches inside the mouth (leukoplakia) that can lead to cancer. : A randomised crossover trial. All studied protein-containing clear liquids also contained carbohydrates. For these guidelines, the primary outcomes of interest are pulmonary aspiration and the frequency or severity of adverse consequences associated with aspiration (e.g., pneumonitis). The body of evidence included 9 studies (5 randomized controlled trials,99,100,102,104,106 1 crossover study,35 and 3 prospective cohort studies101,103,105) providing data on 1- and 2-h fasting in pediatric patients. Copyright 2023, the American Society of Anesthesiologists. Gastric fluid volume change after oral rehydration solution intake in morbidly obese and normal controls: A magnetic resonance imaging-based analysis. Preoperative fasting guidelines recommended by the American Society of Anesthesiologists (ASA ) do not allow eating or drinking, for a specific period of time before anesthesia is administered due to the risk of pulmonary aspiration, a serious complication in which stomach contents are drawn into the respiratory tract during breathing. These evidence categories are further divided into evidence levels. A preoperative assessment includes a review of medical records, a physical examination, and a patient survey or interview. Use of ultrasound for gastric volume evaluation after ingestion of different volumes of isotonic solution. The risk of bias for individual studies was evaluated using tools according to study design: for randomized controlled trials, the Cochrane risk of bias tool,16 and for nonrandomized studies, the Risk Of Bias In Non-Randomised Studies of Interventions tool.17 The risk of bias appraisals for only randomized controlled trials were used to support all strength-of-evidence ratings (supplemental figs. buick lacrosse for sale under $10,000. No search for unpublished studies was conducted, and no reliability tests for locating research results were done. A randomized trial of preoperative oral carbohydrates in abdominal surgery. Chewing Gum: A Hazard That Warrants Delaying the Case? 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.. An odds ratio procedure based on the Mantel-Haenszel method for combining study results using 2 x 2 tables was used with outcome frequency data. The original guidelines and the previous update in 2011 was developed by means of a seven-step process. Antiemetics may be preoperatively administered to patients at increased risk of postoperative nausea and vomiting. Most patients in the studies were ASA Physical Status I or II with mean or median body mass index of 25kg/m2 (range, 21 to 33kg/m2; see Appendix). Verify patient compliance with fasting requirements at the time of their procedure. Therefore, to avoid prolonged fasting in children, efforts should be made to allow clear liquids in healthy children as close to 2h before procedures as possible. Effect of a single intravenous dose on pH and volume of gastric aspirate. Evidence concerning patient-reported outcomes comparing 1- to 2-h clear liquid fasting in children was limited to one or two studies per outcome. Guidelines to the practice of anesthesia Revised edition 2022. 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 Com. Patients drinking carbohydrate-containing clear liquids until 2h before their procedures experienced less hunger and thirst compared to fasting (table 2) and less hunger compared to drinking noncaloric clear liquids (table 3). Organic inflammatory response to reduced preoperative fasting time, with a carbohydrate and protein enriched solution: A randomized trial. Clinical significance of pulmonary aspiration during the perioperative period. Comparators of interest include, Carbohydrate- and protein-containing clear liquids alone and in combination. Hypoglycaemia in children before operation: its incidence and prevention. The American Society of Anesthesiologists (ASA) recommends patients to fast from fatty food or meats eight (8) hours prior to surgery, non-human milk or light meal for six (6) hours prior, breast milk for four (4) hours prior, and clear liquids including water, pulp-free juice, and tea or coffee without milk for two (2) hours prior to the Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Cimetidine in the prevention of acid aspiration during anesthesia. According to the American Lung Association, chewing tobacco contains at least 28 chemicals that can lead to various illnesses, including mouth, esophageal, and pancreatic cancers, gum disease, and tooth decay and loss. Effect of preoperative intravenous carbohydrate loading on preoperative discomfort in elective surgery patients. Does preoperative oral carbohydrate treatment reduce the postoperative surgical stress response in lumbar disc surgery? These liquids should not include alcohol. Attenuation of gastric effects of famotidine by preoperative administration of intravenous fluids. Strona gwna / Uncategorized / asa npo guidelines 2020 chewing tobacco. These guidelines aim at reducing the risk for gastric content aspiration to the lowest possible, to avoid associated morbidity, unplanned hospital and/or an intensive care admission. The categories of recommendations in the Grading of Recommendations, Assessment, Development, and Evaluation approach include strong in favor, conditional in favor, conditional against, and strong against an intervention. Surgical fasting guidelines in children: Are we putting them into practice? 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. Anesthesiologists and other anesthesia providers should recognize that these conditions can increase the likelihood of regurgitation and pulmonary aspiration, and that additional or alternative preventive strategies may be appropriate. Gastric emptying time of two different quantities of clear fluids in children: A double-blinded randomized controlled study. No controlled trials were found that address the impact of conducting a review of medical records, physical examination, or survey/interview on the frequency or severity of perioperative pulmonary aspiration of gastric contents.
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