PRE-OPERATIVE FASTING GUIDELINES ROYAL COLLEGE OF NURSING AND THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS By :Pamela Mair

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.

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 patient’s 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

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.

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.

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 cow’s milk may be given up to 6hrs before induction of anaesthesia.

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.

Pre-op Fasting in High*Risk 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.

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