Canadian Association of General Surgeons and American College of Surgeons evidence based reviews in surgery. 14. Preoperative fasting for adults to prevent perioperative complications.
Year: 2005
Type: letter
Study design: Systematic Review
Abstract: Objective: To systematically review the effect of different preoperative fasting regimens (duration, type and volume of permitted intake) on perioperative complications and patient well-being in low-risk patient populations. Data sources: Electronic databases (MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials and National Research Register, UK). Also, experts in the area were consulted and various worldwide anesthesia references lists and personal communications were included. Study selection: Randomized controlled trials that compared the effect of postoperative complications of different preoperative fasting regimens on adults. Outcome measures: Primary outcomes were: rates of adverse events (e.g., aspiration or regurgitation) or those following aspiration, including related morbidity (e.g., aspiration pneumonia) or operation-related death; volume or pH, or both, of gastric contents (on induction of anesthesia); and concentration of marker dye (e.g., bromsulfalein) as an indicator of gastric emptying. Results: Thirty-eight randomized controlled comparisons (made within 22 trials) were identified. Most were based on “healthy” adults who were not considered at risk for regurgitation or aspiration during anesthesia. There was no evidence that the pH volume of participants' gastric contents differed significantly depending on whether they were permitted a shortened preoperative fluid fast or continued the standard fast. Second, participants given a drink of water preoperatively were found to have a significantly lower volume of gastric contents than the participants who followed the standard fasting regimen. The difference was modest and clinically insignificant. There was no indication that the volume of fluid given preoperatively (i.e., high or low) resulted in a difference in outcomes from those that followed a standard fast. Conclusions: There is no evidence to suggest that a shortened fluid fast results in an increased risk of aspiration or related morbidity compared with the standard policy of nil by mouth (NPO) from midnight. Participants permitted to have water preoperatively had significantly lower gastric volumes.
Source: PubMed
Authors: Robin McLeod, William Fitzgerald, Michael Sarr
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2134397838