@article{7193a0c4b95c4b58ba30272382a78dbe,
title = "An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children",
abstract = "The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to patient characteristics, comorbidities, the nature of the procedure and the nature of the anticipated sedation technique. Graded fasting precautions for liquids and solids are then recommended for elective procedures based upon this categorisation of negligible, mild or moderate aspiration risk. This consensus statement can serve as a resource to practitioners and policymakers who perform and oversee procedural sedation in patients of all ages, worldwide.",
keywords = "fasting, NPO guidelines, procedural sedation, pulmonary aspiration, PERIOPERATIVE PULMONARY ASPIRATION, ADVERSE EVENTS, EMERGENCY-DEPARTMENT, PROPOFOL SEDATION, CATARACT-SURGERY, RESPIRATORY COMPLICATIONS, PEDIATRIC-PATIENTS, KETAMINE SEDATION, GASTRIC CONTENTS, INCREASED RISK",
author = "Green, {S. M.} and Leroy, {P. L.} and Roback, {M. G.} and Irwin, {M. G.} and G. Andolfatto and Babl, {F. E.} and E. Barbi and Costa, {L. R.} and A. Absalom and Carlson, {D. W.} and Krauss, {B. S.} and J. Roelofse and Yuen, {V. M.} and E. Alcaino and Costa, {P. S.} and Mason, {K. P.} and {International Committee for the Advancement of Procedural Sedation}",
note = "Funding Information: We thank S. Tamares, MLIS for her expert production of the literature search, and the multiple liaisons from outside organisations who kindly provided their expert input. This manuscript had no outside funding or support. MI has received travel support from Fresenius Kabi and is an editor of Anaesthesia. FB has research grants from the National Health and Medical Research Council, Canberra, Australia and the Royal Children's Hospital Foundation, Melbourne, Australia. LC has research grants from Conselho Nacional de Desenvolvimento Cient{\'i}fico e Tecnol{\'o}gico (CNPq), Coordena{\c c}{\~a}o de Aperfei{\c c}oamento de Pessoal de N{\'i}vel Superior (CAPES) e Funda{\c c}{\~a}o de Amparo {\`a} Pesquisa do Estado de Goi{\'a}s (FAPEG). AA has sponsored research and consultancy fees from The Medicines Company, Orion, and Johnson and Johnson, and unrestricted research grants from Carefusion and Drager. PC is supported by the Brazilian National Research Scientific Research Council. KM receives support from Hospira for investigator-initiated studies and unrestricted educational support for conferences. Upon project completion one committee member elected to not be included in the authorship list. He expressed that the development process was fair, that his views were heard and that he supported the quality of the literature summaries. His decision was based on his caution in making specific recommendations based upon the reported degree of incomplete evidence. Funding Information: This manuscript had no outside funding or support. MI has received travel support from Fresenius Kabi and is an editor of . FB has research grants from the National Health and Medical Research Council, Canberra, Australia and the Royal Children's Hospital Foundation, Melbourne, Australia. LC has research grants from Conselho Nacional de Desenvolvimento Cient{\'i}fico e Tecnol{\'o}gico (CNPq), Coordena{\c c}{\~a}o de Aperfei{\c c}oamento de Pessoal de N{\'i}vel Superior (CAPES) e Funda{\c c}{\~a}o de Amparo {\`a} Pesquisa do Estado de Goi{\'a}s (FAPEG). AA has sponsored research and consultancy fees from The Medicines Company, Orion, and Johnson and Johnson, and unrestricted research grants from Carefusion and Drager. PC is supported by the Brazilian National Research Scientific Research Council. KM receives support from Hospira for investigator‐initiated studies and unrestricted educational support for conferences. Upon project completion one committee member elected to not be included in the authorship list. He expressed that the development process was fair, that his views were heard and that he supported the quality of the literature summaries. His decision was based on his caution in making specific recommendations based upon the reported degree of incomplete evidence. Anaesthesia Publisher Copyright: {\textcopyright} 2019 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists",
year = "2020",
month = mar,
doi = "10.1111/anae.14892",
language = "English",
volume = "75",
pages = "374--385",
journal = "Anaesthesia",
issn = "0003-2409",
publisher = "Wiley",
number = "3",
}