Snacking Before Bedtime

How long before a procedural sedation is fasting required? You know, of course, the American Society of Anesthesiologists guidelines specify: a mini- mum fasting period of 2 hours for clear liquids, 4 hours for breast milk, 6 hours for infant formula and light meals, and 8 hours for solids containing meat or fatty foods.

Of course, anecdotally – if anecdotally means hundreds of thousands of safe sedations – Emergency Physicians have known these restrictions are nonsense.

But, guidelines are best written off published evidence – so, we have a pre-planned analysis of the relationship between fasting time and vomiting from a Canadian cohort study of pediatric sedation. With 6,295 sedations included in their analysis, almost half of whom did not meet solids fasting guidelines, these authors found no relationship between fasting time and vomiting. There were, even, only six instances of intra-procedure vomiting, and fasting duration ranged from 1.7 hours to 17.5 hours – but they all received ketamine. None of the intra-procedure, or ~300 peri-procedural episodes of vomiting, resulted in pulmonary aspiration. No relationship was found between fasting time and any other type of adverse event, either.

So, another useful piece of literature to wave around in committee meetings – both to eliminate any fasting restrictions, and, again, to help demonstrate the safety of EP-performed procedural sedation.

“Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children”
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2680050