[Prevention of aspiration--preoperative fasting. Time for reevaluation of old routines?]

Abstract

The article reviews the epidemiology, pathophysiology and recent clinical research on aspiration prophylaxis and preoperative fasting before surgical procedures. Elective, pain-free patients should be allowed a glass of clear fluid up to two hours before start of anaesthesia. A light meal should be allowed up to four hours before the procedure. The anaesthesist should always make an individual evaluation of patients with pain or gastrointestinal obstruction, or who have received opioids. Aspiration of gastric contents and/or prophylactic use of histamine H2 antagonist or sodium citrate may be considered. The use of prophylactic treatment should always be evaluated against the side-effects of such treatment and the very low occurrence of serious sequelae from aspiration of gastric contents into the lungs.