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ASA 2017 Fasting Guidelines 

 

Fasting Recommendations 

  • Clear liquids: 2 hours 

  • Breast milk: 4 hours 

  • Infant formula: 6 hours 

  • Nonhuman milk: 6 hours 

  • Light meal: 6 hours

  • Fried foods, fatty foods, or meat​: 8 hours 

​

Pharmacologic Therapy 

​

  • Gastrointestinal Stimulants 

    • DO NOT USE ROUTINELY if average risk of reflux/aspiration 

    • Maxeran

      • Good evidence for gastric emptying 

      • No good evidence for reducing acidity 

  • Gastric Acid Reducing Agents 

    • DO NOT USE ROUTINELY if average risk of reflux/aspiration 

    • All H2 receptor antagonists (cimetidine, ranitidine, famotidine) effective for reducing gastric volume & acidity.  Miller says Ranitidine most effective for reducing the gastric volume. 

    • PPI effective for reducing gastric volume & acidity 

    • Insufficient evidence to decide between H2-blocker VS PPI 

  • Antiemetics

    • DO NOT reduce the risk of aspiration in otherwise normal patients

    • Should NOT be routinely used

    • Effective only for PONV 

  • Anticholinergics

    • NOT recommended routinely ​

    • ​Equivocal evidence that they reduce gastric volume or acidity 

  • Reference

    • ​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 on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376-393. doi:10.1097/ALN.0000000000001452

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