Peer-reviewed article
[Specific Fasting Requirements for Special Patient Groups].
Beck C, Greve S, Olotu C ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This document is a medical review of preoperative fasting requirements for different patient groups undergoing anesthesia. It discusses how fasting guidelines have evolved to balance aspiration risk reduction with the negative effects of prolonged fasting. The review identifies vulnerable populations including children, elderly patients, pregnant women, and those with delayed gastric emptying due to medical conditions or medications.
Key points
- Recent practice shifts from standardized fasting recommendations to individualized, shorter fasting periods based on patient risk
- Delayed gastric emptying is a significant risk factor and can result from diabetes, Parkinson's disease, medications like opioids and GLP-1 agonists, or previous surgery
- Children, very elderly, frail patients, pregnant women and women in labor are identified as vulnerable groups with limited compensatory mechanisms
Limitations
This document is about preoperative medical management for surgical patients and does not address child well-being, development, protection, or survival outcomes outside of clinical anesthesia practice. It provides no empirical data on child health outcomes.
Abstract
Recommendations regarding preoperative fasting have been an integral part of anaesthesiological practice for decades. In recent years, in addition to the traditional focus on reducing the risk of aspiration, the pathophysiological consequences of (excessively) long fasting periods have increasingly been taken into consideration. The aim is no longer exclusively to provide standardised recommendations that are applicable to as large a group of patients as possible, but to achieve implementation that results in short, realistic fasting periods for patients.It remains important to reliably identify patients who are at potentially increased risk of perioperative aspiration to individually adjust not only the immediate perioperative procedure but also the preoperative fasting periods. Patients with delayed gastric emptying play a significant role in this context. This can occur idiopathically but also in the context of comorbidities such as diabetes mellitus, Parkinson's disease, autoimmune diseases, diseases of the autonomic nervous system or connective tissue (e.g. scleroderma), infections of the gastrointestinal tract or after previous major surgery. In addition, numerous medications - including opioids, tricyclic antidepressants and GLP-1 receptor agonists in particular - can lead to significant delayed gastric emptying.Particularly vulnerable risk groups in connection with excessively long fasting periods are children, the very elderly and frail, pregnant women and women in labour. These groups must be protected from excessively long fasting periods because they have limited compensatory mechanisms.The following overview provides an update on preoperative fasting in children, older people and pregnant women and presents further risk constellations associated with delayed gastric emptying. It can be seen as a best practice recommendation for specific issues.