{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:11:38Z","timestamp":1791353498369,"version":"4.3.1"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"Importance<\/jats:title>Current fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae. Recent studies in children showed support of liberal clear fluid intake; adult physiology can support clear fluid intake, but implementation studies are lacking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the successfulness of implementation of a liberal clear fluid policy with regard to fasting duration, well-being, and safety in adults scheduled for anesthesia.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a quality improvement study conducted from January 2016 to July 2021 at a tertiary referral hospital in the Netherlands. Adults scheduled for nonemergency procedures under anesthesia were included in the study. Patients undergoing obstetrics procedures or those who were intubated preoperatively were excluded.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Stepwise introduction of a liberal fluid fasting policy, allowing for ingestion of clear fluids until arrival at the operating room.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was change in fasting duration. Secondary outcomes were patient well-being, measured as preoperative thirst, amount of fluid ingested, postoperative nausea and vomiting (PONV), and administration of antiemetics. Safety was measured as incidence of regurgitation and aspiration (pneumonia).<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 76\u202f451 patients (mean [SD] age, 56 [17] years; 39\u202f530 male individuals [52%] 36\u202f921) included in the study, 59\u202f036 (78%) followed the standard policy, and 16\u202f815 (22%) followed the liberal policy. Time series analysis showed an estimated fasting duration decrease of 3:07 hours (IQR, 1:36-7:22; P<\/jats:italic>\u2009&amp;lt;\u2009.001) after implementation of the liberal policy. Postimplementation median (IQR) fasting duration was 1:20 (0:48-2:24) hours. The incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10\u202f000 patients, and the incidence of aspiration changed from 1.7 (95% CI, 0.6-2.7) to 2.4 (95% CI, 0.5-4.7) in 10\u202f000 patients. In the liberal policy, thirst feelings decreased (37% [4982 of 8615] vs 46% [3373 of 7362]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). PONV incidence decreased from 10.6% (6339 of 59\u202f636) to 9.4% (1587 of 16\u202f815; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and antiemetic administration decreased from 11.0% (6538 of 59\u202f636) to 9.5% (1592 of 16\u202f815; P<\/jats:italic>\u2009&amp;lt;\u2009.001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Results of this quality improvement study suggest that a liberal fasting policy was associated with a clinically relevant reduction in fasting duration and improved patient well-being with regard to preoperative thirst and PONV. Although a slightly higher incidence of regurgitation could not be ruled out, wider implementation of such a policy may be advocated as results are still within the clinically accepted risks margins. Results suggest that surgical procedures in patients who drink clear fluids within 2 hours before anticipated anesthesia should not be postponed or canceled.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2022.5867","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T16:01:44Z","timestamp":1672848104000},"page":"254","source":"Crossref","is-referenced-by-count":100,"title":["Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety"],"prefix":"10.1001","volume":"158","author":[{"given":"Marije","family":"Marsman","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teus H.","family":"Kappen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Department of Information Technology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisette M.","family":"Vernooij","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelien C.","family":"van der Hout","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith A.","family":"van Waes","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilton A.","family":"van Klei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Toronto General Hospital Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"8","key":"soi220089r1","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1097\/EJA.0b013e3283495ba1","article-title":"Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.","volume":"28","author":"Smith","year":"2011","journal-title":"Eur J Anaesthesiol"},{"issue":"4","key":"soi220089r2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004423","article-title":"Preoperative fasting for adults to prevent perioperative complications.","author":"Brady","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"soi220089r3","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1097\/ALN.0b013e3181fcbfd9","article-title":"Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters.","volume":"114","author":"American Society of Anesthesiologists Committee","year":"2011","journal-title":"Anesthesiology"},{"issue":"4","key":"soi220089r4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2017-000161","article-title":"Preoperative fasting in the department of plastic surgery.","volume":"7","author":"Davies","year":"2018","journal-title":"BMJ Open Qual"},{"issue":"3","key":"soi220089r5","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1016\/j.clnu.2020.08.033","article-title":"Fasting and surgery timing (FaST) audit.","volume":"40","author":"El-Sharkawy","year":"2021","journal-title":"Clin Nutr"},{"key":"soi220089r6","first-page":"971","article-title":"How come nothing changed? reflections on the fasting-time project.","volume":"270","author":"Hertzum","year":"2020","journal-title":"Stud Health Technol Inform"},{"issue":"1","key":"soi220089r7","doi-asserted-by":"publisher","DOI":"10.2196\/15905","article-title":"Preoperative fasting practices across 3 anesthesia societies: survey of practitioners.","volume":"3","author":"Merchant","year":"2020","journal-title":"JMIR Perioper Med"},{"issue":"8","key":"soi220089r8","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1111\/pan.2017.27.issue-8","article-title":"Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward.","volume":"27","author":"Newton","year":"2017","journal-title":"Paediatr Anaesth"},{"issue":"1","key":"soi220089r9","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12913-020-06039-y","article-title":"Effects of a short message service (SMS) by cellular phone to improve compliance with fasting guidelines in patients undergoing elective surgery: a retrospective observational study.","volume":"21","author":"Zia","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"soi220089r10","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.jopan.2020.09.002","article-title":"Preoperative fasting guidelines: where are we now? findings from current practices in a tertiary hospital.","volume":"36","author":"Zhu","year":"2021","journal-title":"J Perianesth Nurs"},{"issue":"4","key":"soi220089r11","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1213\/01.ane.0000237296.57941.e7","article-title":"The incidence and outcome of perioperative pulmonary aspiration in a university hospital: a 4-year retrospective analysis.","volume":"103","author":"Sakai","year":"2006","journal-title":"Anesth Analg"},{"issue":"4","key":"soi220089r12","doi-asserted-by":"publisher","first-page":"4037","DOI":"10.21037\/apm","article-title":"Perioperative pulmonary aspiration and regurgitation without aspiration in adults: a retrospective observational study of 166,491 anesthesia records.","volume":"10","author":"Sun","year":"2021","journal-title":"Ann Palliat Med"},{"issue":"2","key":"soi220089r13","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1213\/00000539-200108000-00050","article-title":"Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice.","volume":"93","author":"Ng","year":"2001","journal-title":"Anesth Analg"},{"issue":"8","key":"soi220089r14","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1111\/anae.v75.8","article-title":"Breaking the fast for procedural sedation: changing risk or risking change?","volume":"75","author":"McCracken","year":"2020","journal-title":"Anaesthesia"},{"issue":"3","key":"soi220089r15","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1213\/ANE.0000000000005589","article-title":"Pro-con debate: 1- vs 2-hour fast for clear liquids before anesthesia in children.","volume":"133","author":"Disma","year":"2021","journal-title":"Anesth Analg"},{"issue":"8","key":"soi220089r16","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1111\/pan.12667","article-title":"Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite.","volume":"25","author":"Andersson","year":"2015","journal-title":"Paediatr Anaesth"},{"issue":"8","key":"soi220089r17","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1111\/pan.v30.8","article-title":"Impact of clear fluid fasting on pulmonary aspiration in children undergoing general anesthesia: results of the German prospective multicenter observational (NiKs) study.","volume":"30","author":"Beck","year":"2020","journal-title":"Paediatr Anaesth"},{"issue":"3","key":"soi220089r18","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/j.bja.2018.02.065","article-title":"Liberal fluid fasting: impact on gastric pH and residual volume in healthy children undergoing general anaesthesia for elective surgery.","volume":"121","author":"Schmidt","year":"2018","journal-title":"Br J Anaesth"},{"issue":"5","key":"soi220089r19","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1093\/bja\/aer058","article-title":"Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. part 1: anaesthesia.","volume":"106","author":"Cook","year":"2011","journal-title":"Br J Anaesth"},{"issue":"3","key":"soi220089r20","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1111\/pan.2019.29.issue-3","article-title":"SPANZA endorses 1-hour clear fluid fasting consensus statement.","volume":"29","author":"Linscott","year":"2019","journal-title":"Paediatr Anaesth"},{"issue":"8","key":"soi220089r21","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1007\/s12630-019-01382-z","article-title":"Canadian Pediatric Anesthesia Society statement on clear fluid fasting for elective pediatric anesthesia.","volume":"66","author":"Rosen","year":"2019","journal-title":"Can J Anaesth"},{"issue":"1","key":"soi220089r22","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/EJA.0000000000001599","article-title":"Preoperative fasting in children: a guideline from the European Society of Anaesthesiology and Intensive Care.","volume":"39","author":"Frykholm","year":"2022","journal-title":"Eur J Anaesthesiol"},{"issue":"3","key":"soi220089r23","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1111\/anae.v75.3","article-title":"An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children.","volume":"75","author":"Green","year":"2020","journal-title":"Anaesthesia"},{"issue":"5","key":"soi220089r24","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1097\/EJA.0000000000000760","article-title":"Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: a retrospective analysis.","volume":"35","author":"McCracken","year":"2018","journal-title":"Eur J Anaesthesiol"},{"key":"soi220089r25","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.ejpb.2018.03.002","article-title":"Interindividual and intraindividual variability of fasted state gastric fluid volume and gastric emptying of water.","volume":"127","author":"Grimm","year":"2018","journal-title":"Eur J Pharm Biopharm"},{"issue":"12","key":"soi220089r26","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1111\/pan.v30.12","article-title":"Ultrasound assessment of gastric emptying time after intake of clear fluids in children scheduled for general anesthesia\u2014a prospective observational study.","volume":"30","author":"Beck","year":"2020","journal-title":"Paediatr Anaesth"},{"issue":"3","key":"soi220089r27","doi-asserted-by":"publisher","first-page":"e85","DOI":"10.1016\/j.bja.2021.06.006","article-title":"Gastric fluid volume in adults after implementation of a liberal fasting policy: a prospective cohort study.","volume":"127","author":"Marsman","year":"2021","journal-title":"Br J Anaesth"},{"issue":"1","key":"soi220089r28","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1093\/bja\/aeu151","article-title":"Ultrasound assessment of gastric content and volume.","volume":"113","author":"Van de Putte","year":"2014","journal-title":"Br J Anaesth"},{"issue":"8","key":"soi220089r29","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1111\/aas.2005.49.issue-8","article-title":"Preoperative fasting guidelines: an update.","volume":"49","author":"S\u00f8reide","year":"2005","journal-title":"Acta Anaesthesiol Scand"},{"issue":"4","key":"soi220089r30","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1093\/bja\/71.4.503","article-title":"Effects of giving water 20-450 mL with oral diazepam premedication 1-2 h before operation.","volume":"71","author":"S\u00f8reide","year":"1993","journal-title":"Br J Anaesth"},{"issue":"6","key":"soi220089r31","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1097\/ACO.0000000000000920","article-title":"Nulla per os (NPO) guidelines: time to revisit?","volume":"33","author":"Friedrich","year":"2020","journal-title":"Curr Opin Anaesthesiol"},{"key":"soi220089r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.11.036","article-title":"Two hours too long: time to review fasting guidelines for clear fluids.","author":"Morrison","year":"2020","journal-title":"Br J Anaesth"},{"issue":"6","key":"soi220089r33","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s00101-021-00918-7","article-title":"[Preoperative fluid fasting: establishment of a liberal fluid regimen using fasting cards].","volume":"70","author":"R\u00fcggeberg","year":"2021","journal-title":"Anaesthesist"},{"issue":"12","key":"soi220089r34","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1007\/s12630-015-0492-y","article-title":"Reporting critical incidents in a tertiary hospital: a historical cohort study of 110,310 procedures.","volume":"62","author":"Munting","year":"2015","journal-title":"Can J Anaesth"},{"issue":"1","key":"soi220089r35","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-021-01235-8","article-title":"Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions.","volume":"21","author":"Schaffer","year":"2021","journal-title":"BMC Med Res Methodol"},{"issue":"5","key":"soi220089r36","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/S2213-2600(17)30116-9","article-title":"Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe.","volume":"5","author":"Habre","year":"2017","journal-title":"Lancet Respir Med"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2799837\/jamasurgery_marsman_2023_oi_220089_1678202793.98534.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T16:14:10Z","timestamp":1678292050000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2799837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,1]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2022.5867","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2023,3,1]]}}}