Is it time to rethink fasting times in the emergency department?

Chumpitazi, CE, Camp, EA, Bhamidipati, DR, et al. “Shortened Preprocedural Fasting in the Pediatric Emergency Department.” The American Journal of Emergency Medicine, vol. 36, no. 9, 2018, pp. 1577–1580.

Carmen D. Sulton, MD

The relationship between pre-procedural fasting times and aspiration and/or pulmonary complications are often a topic in anesthesia and sedation literature. In particular, fasting or nil per os (NPO) guidelines for urgent procedures outside of the operating room continue to be vague.  Prolonged fasting times can often be difficult for both emergency providers and families to manage. The American Society of Anesthesiologists (ASA) guidelines focus on 2 hours of fasting for clear liquids and up to 8 hours for full fatty meals. The American College of Emergency Physicians (ACEP) states that procedures in the emergency department (ED) setting should not be delayed based on fasting times alone. Many studies looking specifically at fasting times and adverse events often are under-powered, or may not focus specifically on patients in the ED setting.  read more