Guideline
The following guideline recommendations are evidence-based. You will see that each recommendation is given a letter according to a grading scheme.
The D grading encompasses consensus decisions made on the basis of expert opinion that, in many cases, is underpinned by evidence that is indirect or only partially applicable (for example, a randomised trial that provides evidence for what should not be done, but cannot be used to say what should be done).
- A summary of the evidence on which the guidance is based is provided in the full guideline on perioperative fasting in adults and children (PDF 2.43MB) [see how to access PDF files].
- Summary recommendations are given separately for adults and children. Recommendations are also summarised in the quick reference guide.
Reference is also made to 'healthy' and 'higher-risk' patients. The former category is defined as patients who are ASA I-II without gastrointestinal disease or disorders.
'Higher-risk' refers to groups of patients who are expected to be at increased risk of regurgitation and aspiration, such as those who have gastro-oesophageal reflux, obesity and diabetes. The anaesthetic team should decide the most appropriate risk category for each patient.
Some of the recommendations state that the patients may have clear fluids 'up to two hours before induction of anaesthesia'. This means that two hours is the recommended minimum time before induction of anaesthesia for that patient, but the patient should also be encouraged to take clear fluids as close as possible to two hours preoperatively.
Guideline review
This version of the clinical guideline for perioperative fasting will be updated in line with the update of Cochrane systematic reviews on preoperative fasting for adults to prevent perioperative complications and preoperative fasting for children to prevent perioperative complications which are currently in process. It is anticipated that these will be published in early 2013.