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Cited by 375Enhanced Recovery After SurgeryDietary Effects on HealthAirway Management and Intubation Techniques

2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration—A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting *

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Joshi, Girish P., Abdelmalak, Basem B., Weigel, Wade A., Harbell, Monica W., Kuo, Catherine I., Soriano, Sulpicio G., Stricker, Paul A., Tipton, Tommie +5 more·2023·Anesthesiology
DOI 10.1097/aln.0000000000004381
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Abstract

These practice guidelines are a modular update of the “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.” The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.

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Registry

Crossref · 10.1097/aln.0000000000004381

Cites

178 of 178 references verified0 citation errors · 0 not checkable

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  • Several studies have reported cases of regurgitation, vomiting, and aspiration in patients using GLP-1 RAs despite adherence to the ASA fasting guidelines.

    “Several studies have reported cases of regurgitation, vomiting, and aspiration in patients using GLP-1 RAs despite adherence to the fasting guidelines established by the American Society of Anesthesiologists (ASA), which recommend fasting for clear liquids up to two hours before surgery, light meals up to six hours before, and fatty meals up to eight hours before anesthesia induction [42].”

    From Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia (2026) · cites this paper as [42]

    The Background (page not specified) states that ASA guidelines allow clear liquids until two hours before anesthesia. The Clinical Outcomes section (page not specified) does not report aspiration in the trials it summarizes, and the retrieved passages do not describe cases involving GLP-1 receptor agonists despite guideline-compliant fasting. The copy also does not establish the sentence’s six-hour light-meal or eight-hour fatty-meal intervals. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Prolonged preoperative fasting (traditionally described as nothing by mouth after midnight) is not recommended and may lead to hypovolemia, hypoglycemia, ketoacidosis, and decreased patient satisfaction.

    “Prolonged preoperative fasting (traditionally described as nothing by mouth after midnight) is not recommended and may lead to hypovolemia, hypoglycemia, ketoacidosis, and decreased patient satisfaction.144,145”

    From Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (part 1)—2025 update (2026) · cites this paper as [144]

    The Summary recommends clear liquids until 2 hours before surgery, and the Comment links prolonged fasting to dehydration, hypotension, and reduced well-being. The paper reports higher satisfaction with carbohydrate-containing liquids than with noncaloric liquids, but its fasting comparison does not establish a satisfaction difference. Our copy does not identify hypoglycemia or ketoacidosis as consequences of prolonged fasting. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Cites

Flagged first, then by citations

Research works printed but not linked: 14

  1. [1]1. Warner MA, Warner ME, Weber JG: Clinical signifi- cance of pulmonary aspiration during the periopera- tive period. Anesthesiology 1993; 78:56-62
  2. [23]23. Dock-Nascimento DB, Aguilar-Nascimento JE, Linetzky Waitzberg D: Ingestion of glutamine and maltodextrin two hours preoperatively improves insulin sensitivity after surgery: A randomized, dou- ble blind, controlled trial. Rev Col Bras Cir 2012; 39:449-55
  3. [44]44. Yilmaz N, Cekmen N, Bilgin F, Erten E, Ozhan MO, Cosar A: Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to pre- operative fasting. J Res Med Sci 2013; 18:827-32
  4. [52]52. Feguri GR, Lima PR, Lopes AM, Roledo A, Marchese M, Trevisan M, Ahmad H, Freitas BB, Aguilar-Nascimento JE: Clinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft sur- gery. Rev Bras Cir Cardiovasc 2012; 27:7-17
  5. [54]54. Marquini GV, Pinheiro FES, Vieira AUC, Pinto RMC, Uyeda M, Girao M, Sartori MGF: Effects of preopera- tive fasting abbreviation with carbohydrate and protein solution on postoperative symptoms of gynecological surgeries: Double-blind randomized controlled clinical trial. Rev Col Bras Cir 2020; 46:e20192295
  6. [66]66. Garcia AKA, Furuya RK, Conchon MF, Rossetto EG, Dantas RAS, Fonseca LF: Menthol chewing gum on preoperative thirst management: Randomized clinical trial. Rev Lat Am Enfermagem 2019; 27:e3180
  7. [68]68. Hamid K, Masoud L, Reza FH, Mehran G, Karmella K: Comparison of different non-pharmacological preop- erative preparations on gastric fluid volume and acidity: A randomized controlled trial. Anaesth Pain Intensive Care 2012; 16:165-8
  8. [85]85. Carvalho C, Carvalho AA, Preza ADG, Nogueira PLB, Mendes KBV, Dock-Nascimento DB, Aguilar- Nascimento JE: Metabolic and inflammatory benefits of reducing preoperative fasting time in pediatric sur- gery. Rev Col Bras Cir 2020; 47:e20202353 114.
  9. [134]134. Blum CL, Akerman M, Callari M, Jordan E, Capozzi JD: Association of nausea and length of stay with car- bohydrate loading prior to total joint arthroplasty. J Clin Outcomes Manag 2019; 26:175-9 166.
  10. [137]137. Bisinotto FMB, Naves AA, Lima HM, Peixoto ACA, Maia GC, Resende Junior PP, Martins LB, Silveira L: Use of ultrasound for gastric volume evalua- tion after ingestion of different volumes of isotonic solution. Braz J Anesthesiol (English Edition) 2017; 67:376-82 169.
  11. [141]141. Jian WL, Zhang YL, Xu JM, Xia SY, Zeng H, Dai RP, Li H: Effects of a carbohydrate loading on gastric emptying and fasting discomfort: An ultrasonography study. Int J Clin Exp Med 2017; 10:788-94 173.
  12. [148]148. Jabbari Moghaddam Y, Seyedhejazi M, Naderpour M, Yaghooblua Y, Golzari SE: Is fasting duration import- ant in post adenotonsillectomy feeding time? Anesth Pain Med 2014; 4:e10256 180.
  13. [152]152. Gawecka A, Mierzewska-Schmidt M: Tolerance of, and metabolic effects of, preoperative oral carbohydrate administration in children-A pre- liminary report. Anaesthesiol Intensive Ther 2014; 46:61-4 184.
  14. [153]153. Wang H, Zou Y, Xie H, Chen Y, Fu Q, Chen Y: The effect of a new preoperative fasting regime on the subjective perception, postoperative recovery, post- operative complications, and satisfaction in pediatric patients. Int J Clin Exp Med 2020; 13:9585-92 185.

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Authors
Joshi, G. P., Abdelmalak, B. B., Weigel, W. A., Harbell, M. W., Kuo, C. I., Soriano, S. G., Stricker, P. A., Tipton, T., Grant, M. D., Marbella, A. M., Agarkar, M., Blanck, J. F., & Domino, K. B.
Corresponding author
Domino, Karen B.
ORCID
Venue
Anesthesiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-01-11
Volume
138
Issue
2
Pages
132-151
ISSN
  • 0003-3022 (ISSN-L)
  • 1528-1175
DOI
10.1097/aln.0000000000004381
OpenAlex
W4315620682
Semantic Scholar
7aefafc173b1e95fe158403650492c132038e176
Cited by
375
References
178
Citations by year
2026: 128 · 2025: 119 · 2024: 89 · 2023: 39
FWCI
100.11
Type
journal article
Language
en
Open access
Locations
  • Anesthesiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
Keywords
preoperative fasting, protein supplementation, chewing gum, pulmonary aspiration, elective procedures
MeSH terms
Anesthesiologists, Chewing Gum, Child, Fasting, Humans, Preoperative Care, Elective Surgical Procedures

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