Preoperative or Pre-procedural Fasting Guidelines in Patients Undergoing Elective Surgery and Procedures by the Royal College of Anesthesiologists of Thailand

Main Article Content

Suwimon Tangwiwat
Mingkwan Wongyingsinn
Cattleya Kasemsiri
Pornarun Charoenraj
Nutchanart Bunchungmongkol
Neranchala Soonthornkes
Krisana Nongnuang
Varinee Lekprasert
Ngamjit Pattaravit
Duenpen Horatanaruang
Viranut Tirasuntornwong
Mitthira Pinsopon
Thidarat Ariyanuchitkul
Somboon Thienthong
Suwannee Suraseranivongse


This practice guidelines have been systematically complied from scientific evidence. Based on recommendations from the 2017 American Society of Anesthesiologists and the previous studies for preoperative fasting and the use of pharmacologic agents, this guidelines applied to the healthy patients undergoing elective surgery and procedures. The authors developed this guidelines to assist the practitioner and patient in making decisions on preoperative fasting to reduce the risk of pulmonary aspiration. This practice guidelines can be implemented as a local institutional policy as appropriate.

Article Details

Special Articles


1. 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. Anesthesiology
2. Shanmugam S, Goulding G, Gibbs NM, Taraporewalla K,
Culwick M. Chewing gum inthe preoperativefasting period:
an analysis of de-identified incidents reported to webAIRS.
AnaesthIntens Care2016;44:281-4.
3. Ouanes JP, Bicket MC, Togioka B, Tomas VG, Wu CL,
MurphyJD.Theroleof perioperativechewing gumon gastric
fluid volume and gastric pH: a meta-analysis. J Clin Anesth
4. Valencia JA, Cubillos J, Romero D, et al. Chewing gum for
1 h does not change gastric volume in healthy fasting
subjects. a prospective observational study. J Clin Anesth
5. Walker RW. Pulmonary aspiration in pediatric anesthetic
practice in the UK: a prospective survey of specialist
pediatric centers over a one-year period. Paediatr anaesth
6. HabreW, Disma N, Virag K,etal. Incidenceofseverecritical
events in paediatricanaesthesia(APRICOT):a prospective
multicentre observational study in 261 hospitals in Europe.
Lancet Respira Med 2017;5:412-25.
7. Beck CE, Rudolp D, Becke-Jakob K,etal. Real fasting times
and incidenceof pulmonaryaspirationinchildren: resultsof
a German prospective multicenter observational study.
8. Pfaff KE, Tumin D, Miller R, Beltran RJ, Tobias JD, Uffman
JC. Perioperativeaspirationeventsinchildren:areport from
the Wake Up Safe Collaborative. Paediatranaesth2020;30:
9. Klanarong S, Suksompong S, Hintong T, Chau-InW,Jantorn
P, WerawatganonT. Perioperative pulmonaryaspiration:an
analysis of 28 reports from the Thai Anesthesia Incident
Monitoring Study (Thai AIMS). J Med Assoc Thai 2011;94:
10. Charuluxananan S, Punjasawadwong Y, Pitimana-aree S,
et al. Perioperative and Anesthetic Adverse events in
Thailand (PAAd Thai) incident reporting study: anesthetic
profilesand outcomes. Asian Biomed 2017;11:21-32.
11. Samantaray A. Pulmonary aspiration of gastric contents:
preventionand prophylaxis. J Clin Sci Res2014;3:243-50.
12. FrykholmP, Schindler E, Sumpelmann R,Walker R,WeissM.
Preoperativefasting inchildren: review ofexisting guidelines
and recent developments. Br J Anaesth2018;120:469-74.
13. Hellström PM, Grybäck P, Jacobsson H. The physiology of
gastric emptying. Best Pract Res Clin Anaesthesiol 2006;
14. Schmitz A, Kellenberger CJ,Liamlahi R, Studhalter M,Weiss
M. Gastric emptying after overnight fasting and clear fluid
intake: a prospective investigation using serial magnetic
resonance imaging in healthy children. Br J Anaesth 2011;
15. Beck CE, ChandrakumarT, Sümpelmann R,etal. Ultrasound
assessment of gastric emptying time after intake of clear
fluids in children scheduled for general anesthesiaa prospective observational study. Paediatr Anaesth 2020;
16. OkabeT,Terashima H, Sakamoto A. Determinantsof liquid
gastricemptying:comparisons betweenmilkand isocalorically
adjusted clear fluids. Br J Anaesth2015;114:77-82.
17. Maughan RJ,LeiperJB, Vist GE. Gastricemptying and fluid
availability after ingestion of glucose and soy protein
hydrolysatesolutions in man. Exp Physiol2004;89:101-8.
18. Calbet JA, MacLean DA. Role of caloric content on gastric
emptying inhumans. J Physiol1997;498:553-9.
19. Maerz LL, Sankaran H, Scharpf SJ, Deveney CW. Effect of
caloric content and composition of a liquid meal on gastric
emptying intherat. Am J Physiol1994;267:R1163-7.
20. Zhang YL,LiH, ZengH,LiQ,QiuLP,DaiRP.Ultrasonographic
evaluationof gastricemptying after ingesting carbohydraterich drinkinyoung children:arandomized crossoverstudy.
Paediatr Anaesth2020;30:599-606.
21. Bonner JJ, Vajjah P, Abduljalil K, et al. Does age affect
gastricemptying time? Amodel-basedmeta-analysisof data
from prematureneonatesthroughtoadults. Biopharm Drug
22. Schmidt AR, Buehler P, Seglias L, et al. Gastric pH and
residual volume after 1 and 2 h fasting time for clear fluids
inchildren. Br J Anaesth2015;114:477-82.
23. Irwin R, Gyawali I, Kennedy B, Garry N, Milne S, Tan T. An
ultrasound assessmentof gastricemptying following tea with
milk in pregnancy: A randomised controlled trial. Eur J
24. Falconer R, Skouras C, Carter T, Greenway L, Paisley AM.
Preoperative fasting: current practice and areas for
improvement. Updates Surg 2014;66:31-9.
25. Disma N, Thomas M, Afshari A, Veyckemans F, De Hert S.
Clear fluids fasting for elective paediatric anaesthesia: The
European Societyof Anaesthesiologyconsensusstatement.
Eur J Anaesthesiol2019;36:173-4.
26. Fawcett WJ, Thomas M. Pre-operative fasting in adults and
children: clinical practice and guidelines. Anaesthesia
27. Sarin A, ChenLL,Wick EC. Enhanced recoveryaftersurgeryPreoperative fasting and glucose loading-a review. J Surg
28. El-Sharkawy AM, Daliya P,Lewis-Lloyd C,etal.Fasting and
surgery timing (FaST)audit. Clin Nutr2021;40:1405-12.
29. de Aguilar-NascimentoJE, Dock-Nascimento DB. Reducing
preoperativefasting time:atrend based onevidence.World
J Gastrointest Surg 2010;2:57-60.
30. Dennhardt N, Beck C, Huber D,etal. Impactof preoperative
fasting timeson blood glucoseconcentration,ketone bodies
and acid-base balanceinchildrenyounger than36 months:
a prospective observational study. Eur J Anaesthesiol
31. Simpao AF, WuL, Nelson O,etal. Preoperativefluid fasting
times and postinduction low blood pressure in children:
aretrospectiveanalysis. Anesthesiology2020;133:523-33.
32. Antozzi P, SotoF, AriasF,etal. Developmentofacute gouty
attack in the morbidly obese population after bariatric
surgery. Obes Surg 2005;15:405-7.
33. Zhou W, Luo L. Preoperative prolonged fasting causes
severe metabolic acidosis: a case report. Medicine 2019;
34. DesboroughJP.Thestressresponsetotraumaand surgery.
Br J Anaesth2000;85:109-17.
35. Smith AF, Vallance H, Slater RM. Shorter preoperative fluid
fasts reduce postoperativeemesis. BMJ1997;314:1486.
36. NobaL,Wakefield A. Arecarbohydrate drinks moreeffective
than preoperativefasting:asystematicreview of randomised
controlled trials. J Clin Nurs2019;28:3096-116.
37. Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O.
Preoperative oral carbohydrate treatment attenuates
immediate postoperative insulin resistance. Am J Physiol
Endocrinol Metab 2001;280:E576-83.
38. Ljungqvist O,Thorell A, Gutniak M, HäggmarkT, Efendic S.
Glucose infusion instead of preoperative fasting reduces
postoperative insulin resistance. J Am Coll Surg 1994;178:
39. Thiele RH, Raghunathan K, Brudney CS, et al. American
Society for Enhanced Recovery (ASER) and Perioperative
Quality Initiative (POQI) joint consensus statement on
perioperativefluidmanagement withinanenhanced recovery
pathway for colorectal surgery. Perioper Med (Lond) 2016;
40. HauselJ,NygrenJ,LagerkranserM,etal. A carbohydrate-rich
drink reduces preoperative discomfort in elective surgery
patients. Anesth Analg 2001;93:1344-50.
41. Hausel J, Nygren J, Thorell A, Lagerkranser M, Ljungqvist
O. Randomized clinical trialof theeffectsoforal preoperative
carbohydrates on postoperative nausea and vomiting after
laparoscopiccholecystectomy.TheBrJ Surg 2005;92:415-21.
42. Cakar E, Yilmaz E, Cakar E, Baydur H. The effect of
preoperative oral carbohydrate solution intake on patient
comfort: A randomized controlled study. J Perianesth Nurs
43. KaskaM,GrosmanovaT, Havel E,etal.Theimpactand safety
versusfasting incolorectalsurgery--arandomized controlled
trial. Wien Klin Wochenschr2010;122:23-30.
44. Helminen H, Viitanen H, Sajanti J. Effect of preoperative
intravenouscarbohydrateloading on preoperative discomfort
inelectivesurgery patients. EurJ Anaesthesiol2009;26:123-7.