Prolonged preoperative fasting times for healthy elective cases have been extrapolated from the aspiration risk of ‘full-stomach’ emergency cases. Methods: In 3 months period, this descriptive study was conducted on 250 patients who scheduled for elective eye surgery. The authors of this review would argue that the reasons for a change, at least in small children, in whom the adverse effects of prolonged fasting may be more significant, outweigh the arguments against. These guidelines are aimed at ensuring acceptable health of pediatric patients and optimizing the experience of surgery in children and their parents [ 3 Using a structured quality-improvement programme, Newton and colleagues. In this review, we examine the physiological basis for various fasting recommendations, the temporal relationship between fluid intake and residual gastric content, and the pathophysiological effects of preoperative fasting, and review recent publications of various attempts to reduce the incidence of prolonged fasting in children. En, In a recent multicentre trial with more than 139 000 procedural sedations or anaesthetics in children, the incidence of aspiration was reported to be similar whether the children were fasted or not. Minerva Anestesiol. The authors of this review conclude that, based on the current evidence, other paediatric hospitals could consider doing the same. Curr Opin Anaesthesiol. Dennhardt and colleagues. It is widely recognised that prolonged fasting for elective surgery in both children and adults serves no purpose, adversely affects patient well-being and can be detrimental. In this review, we will analyse the risk of pulmonary aspiration in paediatric anaesthesia; examine the physiological basis for various fasting recommendations, the temporal relationship between fluid intake and residual gastric content, and the pathophysiological effects of preoperative fasting; and review recent publications of various attempts to reduce the incidence of prolonged fasting in children. Epub 2018 Oct 30. Copyright © 2020 Elsevier Inc. except certain content provided by third parties. 1.6 Recent media reports (2015) of adverse patient events in association with administration of large volumes of local anaesthetic drugs. Hence, Indian Society of Anaesthesiologists decided to conduct a survey to assess the fasting practices and the food habits across India, which would be subsequently used for developing preoperative fasting guidelines for the Indian population. Preoperative fasting is a traditional procedure to be practiced before surgery; however, it is still debated optimal preoperative fasting time (Taniguchi, Sasaki and Fujita, 2012). Although efforts have been made to determine the extent to which the ASA guidelines for preoperative fasting have … Liberal pre‐operative fasting routines have been implemented in most countries. To address these problems, a few centres have reduced or mitigated the requirements for clear fluid fasting. ... time to review fasting guidelines for clear fluids, British Journal of Anaesthesia, 10.1016/j.bja.2019.11.036, (2020). A suggestion for a revision of the guidelines for preoperative fasting in children is provided. The evidence underpinning these guidelines however, was scattered across a range of journals, in a variety of languages, used a variety of outcome measures and methodologies to evaluate fasting regimens that differed in duration and the type and volume of intake permitted during a restricted fasting period. Pulmonary aspiration is rare and associated with nearly no mortality in paediatric anaesthesia. 4.2 Emergency patients: a) Follow the guidance for elective patients in Section 4.1 but recognize that the …  |  •Preoperative fasting reduces the risk of pulmonary aspiration by allowing time for gastric emptying. Gastric pH and residual volume after 1 and 2 h fasting time for clear fluids in children. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. Accepted: Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome. 2020 Dec;33(6):740-745. doi: 10.1097/ACO.0000000000000920. The current guidelines are well established and seem reasonable. Aims: An audit was undertaken to determine the length of preoperative fasting time in children and its causes. The ASA and ESA guidelines regard milk as a solid, as the proteins contained in milk coagulate in the acidic environment of the ventricle. These guidelines are rarely adhered to in practice. However, recent research has demonstrated that even a 2 h fasting interval for fluids does not guarantee an empty stomach. NLM 2 Pediatric hospitals have recently enacted more liberal preoperative clear fluid fasting guidelines. ... removing urinary catheters, stopping intravenous fluids early and allowing early feeding. Although having a large meal just before anaesthesia is probably a very bad idea, there is no solid evidence in the form of randomized controlled trials linking the length of preoperative fasting with the risk of aspiration of gastric contents during anaesthesia. Although there will be some production of coagulated milk proteins, the greater part of a non-human-milk-based volume may be regarded as clear fluid with a rapid elimination rate, whilst the semi-solid agglutinate is likely to, unless huge quantities are ingested, also be eliminated from the gastric ventricle relatively rapidly, as the absolute volume of solid is small. 2018 Dec;84(12):1413-1419. doi: 10.23736/S0375-9393.18.13042-2. How did we get here? ... To systematically review the effect of different preoperative fasting regimens … We used the Cochrane risk-of-bias tool to assess the methodological quality of included studies. Early postoperative oral fluid intake in paediatric day case surgery influences the need for opioids and postoperative vomiting: a controlled randomized trial. Settings and Design: Cross-sectional study of 50 children below 15 … Please fast from 0200 for food or milk, and continue clear fluids until 0700 Emergency surgery and anesthesia The fasting plan should be … It is now almost 20 yr since the first ASA guidelines on preoperative fasting were published. We have come a long way since the nil‐from‐midnight days, but there is still much more refinement to the pre‐operative fasting process to be done. Prolonged preoperative fasting that exceeds guidelines by more than 2 h causes hunger, discomfort, headache, dehydration, and hypoglycemia. Some of these societies have been updating their guidelines, as such t … The current guidelines have a good track record. Thus, current guidelines have used knowledge about the physiology of gastric emptying outlined earlier to estimate safe fasting intervals for liquids and solids within reasonable limits. In 1974, Thomas. Several studies have reported many children fasting for up to 12 or 15 h in spite of the implementation of the 6–4–2 guideline. Small children have a higher metabolic rate and reduced glycogen stores compared with adults. JBI Database System Rev Implement Rep. 2016. Nil per os guidelines: what is changing, what is not, and what should. Definition of Preoperative Fasting and Pulmonary Aspiration For these guidelines, preoperative fasting is defined as a pre-scribed period of time before a procedure when patients are not allowed the oral intake of liquids or solids. These seven evidence linkages are: (1) preoperative fasting of liquids between 2 and 4 h for adults, (2) preoperative fasting of liquids between 2 and 4 h for children, (3) preoperative metoclopramide, (4) preoperative ranitidine (orally administered), (5) preoperative cimetidine (orally administered), (6) preoperative omeprazole (orally administered), and (7) perioperative ondansetron (intravenously … A recent publication could be seen as an efficient compromise between the two aforementioned strategies. In children <6 months, most recommendations now allow breast‐ or formula milk feeding up to 4 h before anaesthesia. Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Practice guideline recommendations on perioperative fasting: a systematic review. • Only the anaesthetist may adjust these guidelines. Published by Elsevier Ltd. COVID-19 and the Anaesthetist: A Special Series, South African Society of Anaesthesiologists, Special Issue on Mass Casualty Medicine and Anaesthesia: Science and Clinical Practice (PDF), Special Issue on Memory and Awareness in Anesthesia (PDF), Moving to human trials for argon neuroprotection in neurological injury: a narrative review, Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study, Pulmonary aspiration of gastric contents in paediatric anaesthetic practice, Fasting times and the risk of pulmonary aspiration, Association between fasting intervals and residual gastric contents, Prolonged preoperative fasting: pathophysiology and occurrence, New strategies to reduce the incidence of prolonged fasting, Reasons for considering a change of current guidelines for preoperative fasting in children, Conclusion and suggestions for future studies, We use cookies to help provide and enhance our service and tailor content and ads. In the last decades, there have been a number of reports in the anaesthetic literature looking at the issue of pulmonary aspiration in both adult and paediatric practice. By continuing you agree to the Use of Cookies. Recurrent themes from all the recent reports include emergency patients, inadequate anaesthesia, obesity, gastrointestinal pathology, and other factors increasing the likelihood of regurgitation. A recently published model-based meta-analysis of gastric emptying studies indicated only marginally longer mean gastric residence times for infant formula than for breast milk. 2. Exclusion criteria: For patients meeting any of these criteria, stop tube feeds six hours prior to case: • Non-intubated patients or those with a non-cuffed (eg. Ideally, this should be done within the framework of a large multicentre audit carefully monitoring both the benefits and the safety of a more liberal fasting regimen. DOI: Pulmonary aspiration associated with anaesthesia is rare.  |  Fasting times and gastric contents volume in children undergoing deep propofol sedation—an assessment using magnetic resonance imaging: preoperative fasting and gastric contents. However, several reports of very long fasting intervals have also been published, in spite of the implementation of the 6–4–2 fasting regimens. Pulmonary aspiration in pediatric anesthetic practice in the UK: a prospective survey of specialist pediatric centers over a one-year period. Preoperative fasting should be kept to a minimum as excessive fasting leads to metabolic stress that together with the surgical stress response manifests as an acute phase response and insulin resistance, which ultimately can lead to increased morbidity and mortality. For example, gastric motility may be reduced by intestinal obstruction, opioid administration, or the stress of trauma. Crossref; PubMed; Scopus (181) Google Scholar; Translation of internationally advocated best practice in preoperative fasting to the clinical environment has been … COVID-19 is an emerging, rapidly evolving situation. preoperative CHO (Arginaid Water™, 18% carbohydrates, Nestle Health Science, Tokyo, Japan) between 6.00–6:30 a.m. on the morning of surgery. The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, [Article in 2006 Sep;20(3):471-81. doi: 10.1016/j.bpa.2006.02.003. • If a patient appears likely to fast for much longer than these times, please contact the anaesthetist (see below). 2017. Surgical fasting guidelines in children: are we putting them into practice?. Implementation of the American Society of Anesthesiology's guidelines to reduce prolonged fasting times in pediatric preoperative patients: a best practice implementation project. Although advised fasting times for solids remain unchanged, there is good evidence to support a 1-h fast for children, with no increase in risk of pulmonary aspiration. Preoperative Fasting. Please enable it to take advantage of the complete set of features! Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS). Hypoglycaemia in children before operation: its incidence and prevention. All rights reserved. Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite. • The goal of these guidelines is to minimise the fasting times for clear fluids to 1 hour. The evidence for this recommendation is weak and may be an unnecessarily conservative view. JBI Database System Rev Implement Rep. 2016 Oct;14(10):251-262. doi: 10.11124/JBISRIR-2016-003171. Best Pract Res Clin Anaesthesiol. The latest guidelines do not support preoperative fasting, as there is no difference in residual gastric fluid volume, pH or gastric emptying rate following semi-solid meals or … Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective … Clipboard, Search History, and several other advanced features are temporarily unavailable. The guidelines for preoperative fasting have been published by the American Society of Anesthesiologists (ASA) and European Society of Anesthesiologists (ESA). The American Society of Anesthesiologists guidelines for preoperative fasting state that it is appropriate to fast from intake of clear liquids at least 2 hours before elective procedures requiring anesthesia. HHS poor nutrition, MMC adopts the following guidelines for perioperative fasting in intubated patients. Preoperative fasting is the practice of a patient abstaining from oral food and fluid intake for a time before an operation is performed. The main reason for considering an update of the current guidelines is the observation that many children are starved for much longer than they need to. Furthermore, disorders of the oesophagus, such as achalasia, are highly likely to cause accumulation of fluid and solids in the oesophagus. Thus, understanding the pathophysiology of gastric function is paramount in avoiding the risk of truly dangerous regurgitation and aspiration during anaesthesia. Literature screening, data extraction, and … Preoperative fasting is associated with characteristic metabolic changes. Effect of different quantities of a sugared clear fluid on gastric emptying and residual volume in children: a crossover study using magnetic resonance imaging. Major adverse events and relationship to nil per os status in pediatric sedation/anesthesia outside the operating room: a report of the Pediatric Sedation Research Consortium. Preoperative fasting times in elective surgical patients at a referral hospital in Botswana. Definition of Preoperative Fasting and Pulmonary Aspiration For these Guidelines, preoperative fasting is defined as a prescribed period of time before a procedure when patients are not allowed the oral intake of liquids or solids. Recent research has contributed with new insights concerning preoperative fasting in children: firstly, that children are often fasted for unnecessarily long intervals in spite of the implementation of current guidelines; secondly, that prolonged fasting could have detrimental metabolic and behavioural effects in small children; thirdly, that the rationale for 6–4–2 h limits in current guidelines may be questioned; and fourthly, that reducing fasting intervals within or even beyond the 2 h limit may be safe and result in a reduced risk of negative metabolic effects of fasting. The definitive version is held on INsite Documents . Are you thirsty?—fasting times in elective outpatient pediatric patients: pediatric fasting guidelines. Fasting guidelines apply to all forms of anesthesia including general anesthesia, regional blocks and IV procedural sedation 3. Pre-operative fasting guidelines: an update. Data extraction and trial quality assessment was conducted independently by two authors. Background and … These and other guidelines were a great step forward from the NBM-from-midnight rule that was then common practice. 3, 4 Meanwhile, pediatric anesthesia societies in Europe, New Zealand, and Australia have released consensus guidelines allowing shorter minimum clear fluid … Therefore, the aim of the … In a recent audit of almost 120 000 anaesthetics in the United Kingdom, the reported incidence of pulmonary aspiration was 0.02%, similar to two other studies from the last decades. Which are the main reasons for status quo? Recently, several publications have attempted to address the problem of prolonged fasting under the current guidelines. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Publicado por Elsevier España, S.L.U. This is because 250ml of Arginaid Water are approved as a meal (n=46) Control (fasting): Control group, did not receive any preoperative CHO and were fasted starting at midnight on the day of surgical Drafting part of the manuscript and critical revision: R.W. The incidence of pulmonary aspiration is low even with the very liberal 6–4–0 regimen, and there is no physiological or epidemiological evidence that it would increase with a transition from the current guidelines. Pediatric fasting times before surgical and radiologic procedures: benchmarking institutional practices against national standards. The pros and cons of the current guidelines will be addressed, and possible strategies for a future revision will be suggested. Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. NB: Paper copies of this document may not be most recent version. August 12, Nulla Per Os (NPO) guidelines: time to revisit? Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward. Keeping children with these disorders NBM from midnight is prudent. metal) tracheostomy tube • Planned reintubation or airway manipulation procedure (eg. Spanish]. The recent studies show that the main risk period for an aspiration event is during induction, but may also occur during maintenance of anaesthesia or during emergence. © 2017 British Journal of Anaesthesia. Randomised and quasi randomised controlled trials of preoperative fasting regimens for children were identified. By continuing you agree to the,, Preoperative fasting in children: review of existing guidelines and recent developments, American Society of Anesthesiologists Committee, 4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society, Reuse portions or extracts from the article in other works, Redistribute or republish the final article. Data collection and analysis. Toshiyasu SUZUKI, Preoperative Fasting Guidelines ─ History of Development and Challenges for the Future ─, THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA, 10.2199/jjsca.35.192, 35, 2, (192-198), (2015). A model-based meta-analysis of data from premature neonates through to adults. The investigator interviewed with patients before beginning of anesthesia and … The aspiration of stomach contents into the lungs during obstetric anesthesia. paracetamol) reabsorbed in the proximal intestines, magnetic resonance imaging (MRI), and ultrasound imaging (US). Keywords: Tracheostomy creation, exchange Mean preoperative fasting times were 13.34 ± 3.07 h for solids and 12.44 ± 2.82 h for fluids. Gastric ultrasound as a preoperative bedside test for residual gastric contents volume in children. Furthermore, there is lack of knowledge of the variability of the rate of gastric emptying in emergency surgery and in patients with various gastrointestinal mobility disorders, and the role for new modalities, such as gastric ultrasound, to identify cases that do or do not need to be fasted more rigorously than healthy elective patients. This site needs JavaScript to work properly. Modern fasting guidelines … ... 1.5 Fellow input regarding updating of fasting guidelines. Perioperative pulmonary aspiration in infants and children. The rationale for preoperative fasting is to ensure that the patient arrives in the operating theatre with an empty stomach. The combination of patient risk factors with added anaesthetic factors, such as the inappropriate choice of a laryngeal mask and inadequate anaesthesia, is frequently reported. Get the latest research from NIH: This review provides a summary of the physiological, epidemiological, and practical aspects of ensuring safe anaesthesia with regard to fasting in children. In the October issue of the journal (Can J Surg 2005;48:409-11), 1 a group of surgeons reviewed the recent Cochrane analysis 2 on preoperative fasting in adults to prevent perioperative complications.They agreed that the intake of clear oral liquids 2–3 hours preoperatively improved patient well-being. The pros and cons of the current guidelines will be addressed, and possible strategies for a future revision will be suggested. Does age affect gastric emptying time? The safety and benefits of shortened fasting are clear. NIH The practice of perioperative fasting consisting of “being nil by mouth (NBM) from midnight before surgery” combined with a postoperative fast until “recovery of bowel function,” has been a mainstay in surgical realms for nearly three quarters of a century. We detail and discuss herewith the content validity of the … Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Optimized preoperative fasting times decrease ketone body concentration and stabilize mean arterial blood pressure during induction of anesthesia in children younger than 36 months: a prospective observational cohort study. We searched PubMed, EMBASE, the Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG databases for articles published through September 2018. When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients. The review from the Australian Incident Monitoring Study in 1999 report on 133 cases of pulmonary aspiration in adults and children. We use cookies to help provide and enhance our service and tailor content and ads. 1.3 Acknowledgement of scientific evidence of the benefits of timely preoperative assessment and management for issues such as cessation of smoking and treatment of anaemia. Further research is also needed to elucidate the consequences of fasting in the neonatal population, both regarding the volume of gastric contents at induction and the possible detrimental effects of prolonged fasting. The incidence may have decreased during the last decades, judging from several audits published recently. published (Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration, 1999). Gastric emptying is regulated by hormonal, neuronal, and metabolic feedback. Are there any good reasons for changing them? Whilst the understanding of the physiology of gastric emptying may justify a reduction of several of the current fasting limits, it must be stressed that a disease may alter the normal physiology significantly. Gastric emptying after overnight fasting and clear fluid intake: a prospective investigation using serial magnetic resonance imaging in healthy children. •Regurgitation after feeds in infants less than 6 months of age is very common due to the higher intragastric pressure and lower gastro-oesophageal sphincter tone. After just a short overnight fast, the body remains able to cope with the glucose demands placed on it by the muscle, brain, kidney, bone marrow and lymph nodes by the breakdown or glycogen within the liver. A new approach to avoid unnecessary fluid-fasting in healthy children. Fasting from midnight—the history behind the dogma. 2017; 126: 376-393. Perioperative fasting guidelines have been published and updated to standardise practices. The aforementioned studies all suggest that pulmonary aspiration during anaesthesia is a low-risk event in children, but this view should be balanced with two other reports. Gastric emptying may be studied with various methods, including scintigraphy, aspiration of gastric contents via a nasogastric (NG) tube, pharmacokinetic studies of water-soluble substances (e.g. Pre-operative fasting guidelines: an update E. SØREIDE 1,L.I.ERIKSSON 2,G.HIRLEKAR 3,H.ERIKSSON 4,S.W.HENNEBERG 5,R.SANDIN 6,J.RAEDER 7(Task Force on Scandinavian Pre-operative Fasting Guidelines, Clinical Practice Committee Scandinavian Society of Anaesthesiology and Intensive Care Medicine) 1Department of Anaesthesia and Intensive Care, Stavanger University Hospital, Stavanger, … This is intended to prevent pulmonary aspiration of stomach contents during general anesthesia. Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden, Department of Paediatric Anaesthesia, Asklepios Klinik Sankt Augustin, Sankt Augustin, NRW, Germany, Clinic for Anaesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, DE 30625, Germany, Royal Manchester Children's Hospital, Manchester, UK, Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH 8032, Zurich, Switzerland. Many children are fasted excessively in spite of the current guidelines.  |  Find NCBI SARS-CoV-2 literature, sequence, and clinical content: All international professional society guidelines for preoperative fasting recommend 2 h for clear fluids, 4 h for breast milk and 6 h for solids, nonhuman and formula milk in children. Main results 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 Committee on Standards and Practice Parameters. The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6–4–2) of fasting for solids, breast milk, and clear fluids, respectively. Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Prolonged fasting of children before anaesthesia is common in private practice. Writing of the first draft of the paper, design, and final revision: P.F. Following are some major recommendations from the guidelines for safe and effective preoperative fasting and post-operative feeding in pediatric patients Fasting duration of 4 hours for breastmilk, 6 hours for milk and light meals and 8 hours for fatty meals is recommended. Crossref. 8 Surveys have shown that only a few hospitals still keep their patients NPO after midnight, but any culture change in medicine is a slow process. Residual gastric contents volume does not differ following 4 or 6 h fasting after a light breakfast—a magnetic resonance imaging investigation in healthy non-anaesthetised school-age children: four and 6 h fasting in children. Are you hungry? Get the latest public health information from CDC: Think drink! Anesthesiology. Thus, reducing the mean duration of fasting can be achieved either by a comprehensive multi-professional education programme to optimize logistics and coach children to drink as close to the 2 h limit as possible, or by omitting or significantly shortening the 2 h interval otherwise required, to bypass the logistic challenges involved in the former strategy. The aim of this study was to evaluate the adjustment of preoperative NPO time with fasting guidelines in adult elective ophthalmic surgeries in a university educational ophthalmology hospital in Tabriz, Iran. Trial authors were contacted for additional information including adverse events. Impact of preoperative fasting times on blood glucose concentration, ketone bodies and acid–base balance in children younger than 36 months: a prospective observational study. Perioperative pulmonary aspiration is defined as aspiration of gastric con- The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. Current fasting guidelines are outdated. Thus, solid food will pass from the gastric ventricle to the duodenum at a constant rate, whilst clear fluids are eliminated exponentially. Prolonged pre-operative fasting can be an unpleasant experience and result in serious medical complications. However, data are accumulating that many children are still starved for unnecessarily long intervals before operation, with resulting predictable metabolic consequences, such as dehydration, ketoacidosis, and hypoglycaemia. Using a standard pharmacokinetic terminology, gastric emptying of solids may be described as zero-order elimination, whilst fluids follow first-order kinetics. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. 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.

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