Department of Anaesthesia, Critical Care Medicine and Pain Medicine, University Hospital Wuerzburg, Germany.
Curr Opin Anaesthesiol. 2020 Dec;33(6):740-745. doi: 10.1097/ACO.0000000000000920.
Preoperative fasting guidelines are generalized to elective procedures and usually do not distinguish between the ambulatory and inpatient setting. Prevalence of aspiration is low while prolonged preoperative fasting is common clinical reality. Recently, changes in preoperative fasting guidelines have been widely discussed.
Rates of prolonged clear fluid fasting (>4 h) prior to surgery are reported in up to 80% of patients with mean fasting duration of up to 16 h and beyond. Prolonged fasting may result in adverse effects such as intraoperative hemodynamic instability, postoperative delirium, patient discomfort, and extended hospital length of stay. Liberal approaches allowing clear fluids up to 1 h prior to anesthesia or until premedication/call to the operating room have shown no increase in adverse events among children. Various anesthesia societies now encourage clear fluid intake up to 1 h prior to pediatric elective anesthesia. Similar reports in the adult cohort are scarce.
Allowing sips of water until call to the operating room may help reducing prolonged preoperative fasting and improving patient comfort while keeping a flexibility in operating room schedule. The feasibility and safety of a liberal clear fluid fasting regimen among adults undergoing elective anesthesia needs to be evaluated in future studies.
术前禁食指南通常适用于择期手术，但通常无法区分门诊和住院环境。尽管发生误吸的风险较低，但长时间术前禁食是常见的临床现实。最近，术前禁食指南的变化已广泛讨论。
多达 80%的患者在手术前长时间（超过 4 小时）禁食清亮液体，平均禁食时间长达 16 小时甚至更长。长时间禁食可能导致术中血流动力学不稳定、术后谵妄、患者不适和住院时间延长等不良后果。允许在麻醉前 1 小时内或直至术前用药/进入手术室前饮用清亮液体的宽松方法，并未增加儿童的不良事件。现在，许多麻醉学会鼓励儿科择期麻醉前 1 小时内饮用清亮液体。在成人队列中，类似的报道很少。
在手术室呼叫前允许小口饮水，可能有助于减少长时间术前禁食并提高患者舒适度，同时保持手术室时间表的灵活性。在未来的研究中，需要评估允许成人在接受择期麻醉时饮用清亮液体的宽松禁食方案的可行性和安全性。
