Preoperative Fasting Guidelines

Introduction to Fasting Guidelines

The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends that preoperative fasting from midnight is unnecessary in most patients 1
The Enhanced Recovery After Surgery (ERAS) Society confirms that fasting from midnight has been standard practice without scientific evidence behind this dogma 2
The Association of Anaesthetists guidelines explicitly state that fasting times should be kept to a minimum 3

Solid foods should be stopped 6 hours before the procedure, and clear liquids continued until 2 hours before the procedure, as recommended by multiple high-quality guidelines 1, 2, 3
Eating breakfast before a 4 PM procedure improves patient comfort by reducing hunger, thirst, and anxiety 2
Eating breakfast before a 4 PM procedure helps maintain proper glucose levels and reduces insulin resistance 2
Modern fasting guidelines show no increased risk of aspiration with eating before a procedure 1, 2

Patients with uncomplicated type 2 diabetes can generally follow standard fasting guidelines, but should coordinate medication timing with their healthcare provider 2
Obese patients without comorbidities can follow the same fasting guidelines as non-obese patients, although the reference for this is ignored and not included here

Unnecessary prolonged fasting can lead to dehydration, increased thirst, hunger, and anxiety, and should be avoided 1, 2, 3
Clear liquids include water, apple juice, black coffee, tea (with small amounts of milk), and clear broth, and patients should be aware of this to avoid confusion 2