University Hospitals Bristol Foundation Trust, Bristol, UK.
Emerg Med J. 2010 Apr;27(4):254-61. doi: 10.1136/emj.2008.069120.
Emergency physicians frequently undertake emergency procedural sedation in non-fasted patients. At present, no UK guidelines exist for pre-procedural fasting in emergency sedation, and guidelines from the North American Association of Anesthesiologists (ASA) designed for general anaesthesia (GA) are extrapolated to emergency care. A systematic review of the literature was conducted with the aim of evaluating the evidence for risk of pulmonary aspiration during emergency procedural sedation in adults. All abstracts were read and relevant articles identified. Further literature was identified by hand-searching reference sections. Papers were objectively evaluated for relevance against pre-determined criteria. The risk of aspiration in emergency procedural sedation is low, and no evidence exists to support pre-procedural fasting. In several large case series of adult and paediatric emergency procedural sedation, non-fasted patients have not been shown to be at increased risk of pulmonary aspiration. There is only one reported case of pulmonary aspiration during emergency procedural sedation, among 4657 adult cases and 17 672 paediatric cases reviewed. Furthermore, ASA guidelines for fasting prior to GA are based on questionable evidence, and there is high-level evidence that demonstrates no link between pulmonary aspiration and non-fasted patients. There is no reason to recommend routine fasting prior to procedural sedation in the majority of patients at the Emergency Department. However, selected patients believed to be significantly more prone to aspiration may benefit from risk:benefit assessment prior to sedation.
急诊医师经常在未禁食的患者中进行紧急程序镇静。目前,英国没有关于急诊镇静前禁食的指南,北美麻醉师协会(ASA)为全身麻醉(GA)制定的指南被推断用于急诊护理。系统评价了文献,旨在评估成人急诊程序镇静期间发生肺吸入的风险证据。阅读了所有摘要并确定了相关文章。通过手动搜索参考文献部分进一步确定了其他文献。根据预先确定的标准客观评估论文的相关性。在急诊程序镇静中,吸入的风险较低,没有证据支持术前禁食。在几项关于成人和儿科急诊程序镇静的大型病例系列中,未禁食的患者并未显示出肺吸入的风险增加。在审查的 4657 例成人病例和 17672 例儿科病例中,仅报告了一例在急诊程序镇静期间发生肺吸入的病例。此外,ASA 关于 GA 前禁食的指南基于有问题的证据,高水平的证据表明肺吸入与未禁食的患者之间没有联系。在大多数急诊科患者中,没有理由建议在程序镇静前常规禁食。然而,对于那些被认为更容易发生吸入的选定患者,在镇静前进行风险:效益评估可能会受益。