Neobook — clinical reference

In adults

The following fasting guidelines have been adopted from the Canadian Anesthesiologists’ Society, with permission:

Fasting policies apply to all forms of anaesthesia, including sedation. Emergent or urgent procedures should be undertaken after considering the risk of delaying surgery vs the risk of aspiration of gastric contents. Pre-existing medical conditions like delayed gastric emptying in diabetes and gastrointestinal reflux disease should also be considered.

Unless contraindicated, adults should be encouraged to drink clear fluids (including water, pulp-free juice, and tea or coffee without milk) up to two hours before elective surgery.

Table 1: Preoperative fasting times before elective general anaesthesia and sedation in adults

Meat and fried foods	Light meal, toast and dairy	Clear fluids
8 hours	6 hours	2 hours

In children

The Association of Paediatric Anaesthetists of Great Britain and Ireland, the European Society for Paediatric Anaesthesiology, and L’Association des Anesthésistes-Réanimateurs Pédiatriques d’Expression Française agreed, in a joint consensus statement that it is safe and recommended for all children to take clear fluids up to 1 hour before elective general anaesthesia, unless there is a clear contraindication. This ‘1-hour clear fluid policy’ is also endorsed by the Paediatric Anaesthesia Community of South Africa (PACSA).

The ‘1-hour clear fluid policy’ does not increase the risk of pulmonary aspiration. Children are less thirsty, hungry, irritable and nauseous perioperatively. In children less than 36 months, this leads to positive physiological and metabolic effects. Prolonged fasting may be associated with lower systolic BP during anaesthesia.

Unless contraindicated, children should be encouraged to drink clear fluids (including water, pulp-free juice, and tea or coffee without milk) up to one hour before elective surgery.

Table 2: Preoperative fasting times before elective general anaesthesia and sedation in children (0–16 years)

Solid food Cow’s milk Formula milk Fortified milk	Breast milk	Clear fluids
6 hours	4 hours	1 hours

Other recommendations

Fortified breast milk does not prolong gastric emptying and can be encouraged in infants 4 hours before anaesthesia.
Fasting instruction in children with gastro-oesophageal disease does not differ from healthy children.
Obese children follow the same fasting guidelines as non-obese children.
Children with repaired oesophagal atresia or tracheal-oesophagal fistulas without documented gastric delay follow the same fasting guidelines as healthy children.
Children with isolated type I diabetes follow the same guidelines as healthy children.
Children with gastrostomies follow the same guidelines as healthy children.
Early and liberal postoperative fluid intake should be encouraged, if not contraindicated by the surgical procedure.
Gastric ultrasound to assess gastric volume is helpful in clinical decision-making. The cross-sectional area of the antrum is used as a surrogate for gastric content, in the right lateral decubitus position.
Jelly is not considered a clear fluid.
Sweets and chewing gum are considered solid food, although chewing gum does not increase gastric volume or change gastric pH.

Useful sites for further information

South African Society of Anaesthesiologists: www.sasaweb.com
The American Society of Anesthesiologists: https://www.asahq.org/
Difficult Airway Society: https://das.uk.com/guidelines/downloads.html

It is recommended for all children to take clear fluids up to 1 hour before elective general anaesthesia, unless there is a clear contraindication.

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South African Society of Anaesthesiologists (SASA) Practice Guidelines_2022_Reviewed by: A Burke