Although liberal clear-fluid fasting is likely safe for children, similar evidence is still lacking to confirm safety in adults.

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• Sabine Friedrich, Patrick Meybohm, and Peter Kranke.
• Department of Anaesthesia, Critical Care Medicine and Pain Medicine, University Hospital Wuerzburg, Germany.
• Curr Opin Anaesthesiol. 2020 Dec 1; 33 (6): 740-745.

Purpose Of ReviewPreoperative 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.Recent FindingsRates 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.SummaryAllowing 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.

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