Acute aspiration

All patients undergoing general anesthesia should fast preoperatively. Clear fluids of 400 mL or less (water, clear juices, coffee, or tea) up to 2 hours preoperatively, light meals up to 6 hours, and up to 150 mL of clear fluid up to 1 hour before surgery with oral drugs are recommended.[52]Soreide E, Eriksson LI, Hirlekar G, et al. Pre-operative fasting guidelines: an update. Acta Anaesthesiol Scand. 2005 Sep;49(8):1041-7. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1399-6576.2005.00781.x http://www.ncbi.nlm.nih.gov/pubmed/16095440?tool=bestpractice.com [54]American Society of Anesthesiologists. 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. Anesthesiology. 2017 Mar;126(3):376-93. https://journals.lww.com/anesthesiology/fulltext/2017/03000/practice_guidelines_for_preoperative_fasting_and.14.aspx http://www.ncbi.nlm.nih.gov/pubmed/28045707?tool=bestpractice.com ​[115]Brady M, Kinn S, Stuart P, et al. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003 Oct 20;(4):CD004423. https://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004423/frame.html http://www.ncbi.nlm.nih.gov/pubmed/14584013?tool=bestpractice.com ​​

These recommendations do not apply to milk, fat-containing fluids, or solids. For solids, a fasting period of at least 6 hours is recommended. Use of chewing gum and any form of tobacco is discouraged during the last 2 hours before induction of anesthesia because they can increase the gastric content. There are no clear recommendations regarding patients at high risk for aspiration.