Guidelines for Fasting
Preoperative fasting for sedation is controversial. Some authorities, especially in dentistry and emergency medicine, consider it to be unnecessary. Airway reflexes are assumed to be maintained during minimal and moderate sedation, but may be lost during deep sedation. If basic or standard sedation techniques ( Basic or standard sedation ) are planned, fasting is recommended, but not mandatory. I
Preoperative fasting for sedation is controversial. Some authorities, especially in dentistry and emergency medicine, consider it to be unnecessary. Airway reflexes are assumed to be maintained during minimal and moderate sedation, but may be lost during deep sedation. If basic or standard sedation techniques (Basic or standard sedation) are planned, fasting is recommended, but not mandatory. If advanced techniques (Advanced sedation), including dissociative and nondissociative techniques, or deep sedation are planned, the following standard anaesthetic fasting guidelines are recommended:
- Clear fluids, apple juice: two hours. Some clinicians allow clear fluids even one hour before the procedure. A “clear fluid” is defined as fluid without particles.
- Breast milk: four hours.
- Formula feeds and solid food: six hours.
For a procedure to be completed safely, children often need deep sedation for which advanced sedation techniques may be required. When a basic or standard sedation technique is used in non-fasted children and fail, the technique should not be advanced. Rather, the procedure must be abandoned and rescheduled for a later time. In urgent cases, when a procedure cannot be postponed and simple sedation techniques are deemed unsuitable, a GA with rapid sequence induction should be considered.
Children should not have to fast for prolonged periods. Clear fluids should be administered up to two hours before the procedure. This may need some fine planning and good communication with parents/caregivers.
SPs must take note of the consensus statement on fasting before procedural sedation in adults and children by ICAPS.12
SASA Paediatric Guidelines for the Safe use of Procedural Sedation and Analgesia for Diagnostic and Therapeutic Procedures in Children: 2021–2026