An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children.

Autor: Green SM; Department of Emergency Medicine, Loma Linda University, Loma Linda, CA, USA., Leroy PL; Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands., Roback MG; University of Colorado School of Medicine, Aurora, CO, USA., Irwin MG; Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong., Andolfatto G; University of British, Columbia Department of Emergency Medicine, Lions Gate Hospital, North Vancouver, BC, Canada., Babl FE; Department of Emergency Medicine, Royal Children's Hospital, Parkville, Vic., Australia., Barbi E; Department of Pediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy., Costa LR; Department of Pediatric Dentistry, Federal University of Goias, Goiania-Goias, Brazil., Absalom A; Department of Anaesthesia, University of Groningen, University Medical Center Groningen, the Netherlands., Carlson DW; Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USA., Krauss BS; Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA., Roelofse J; Departments of Anaesthesia, University of the Western Cape, Stellenbosch University, Tygerberg, Republic of South Africa., Yuen VM; Department of Anaesthesiology, Hong Kong Children's Hospital and Queen Mary Hospital, University of Hong Kong, Hong Kong., Alcaino E; Department of Paediatric Dentistry, University of Sydney, Westmead Centre for Oral Health, Sydney, NSW, Australia., Costa PS; Department of Pediatrics, Federal University of Goias, Goiania-Goias, Brazil., Mason KP; Department of Anesthesia, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Anaesthesia [Anaesthesia] 2020 Mar; Vol. 75 (3), pp. 374-385. Date of Electronic Publication: 2019 Dec 02.
DOI: 10.1111/anae.14892
Abstrakt: The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to patient characteristics, comorbidities, the nature of the procedure and the nature of the anticipated sedation technique. Graded fasting precautions for liquids and solids are then recommended for elective procedures based upon this categorisation of negligible, mild or moderate aspiration risk. This consensus statement can serve as a resource to practitioners and policymakers who perform and oversee procedural sedation in patients of all ages, worldwide.
(© 2019 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)
Databáze: MEDLINE
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