{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:22:47Z","timestamp":1791919367531,"version":"4.3.4"},"reference-count":94,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T00:00:00Z","timestamp":1575244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    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\u20101984 literature there are no published reports of aspiration\u2010associated mortality in children, no reports of death in healthy adults (\n                    <jats:styled-content style=\"fixed-case\">ASA<\/jats:styled-content>\n                    physical status 1 or 2) and just nine reported deaths in adults of\n                    <jats:styled-content style=\"fixed-case\">ASA<\/jats:styled-content>\n                    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\u2010derived algorithm in which each patient is first risk\u2010stratified during their pre\u2010sedation assessment, using evidence\u2010based 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.\n                  <\/jats:p>","DOI":"10.1111\/anae.14892","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T21:46:38Z","timestamp":1575323198000},"page":"374-385","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":160,"title":["An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children"],"prefix":"10.1111","volume":"75","author":[{"given":"S. M.","family":"Green","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Loma Linda University Loma Linda CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. L.","family":"Leroy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Maastricht University Medical Centre Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. G.","family":"Roback","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine Aurora CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. G.","family":"Irwin","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University of Hong Kong Queen Mary Hospital Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Andolfatto","sequence":"additional","affiliation":[{"name":"University of British Columbia Department of Emergency Medicine Lions Gate Hospital North Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. E.","family":"Babl","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Royal Children's Hospital Parkville Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Barbi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Institute for Maternal and Child Health\u2010IRCCS \u2018Burlo Garofolo\u2019 Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. R.","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry Federal University of Goias Goiania\u2010Goias Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Absalom","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University of Groningen University Medical Center Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. W.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Southern Illinois University School of Medicine Springfield IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. S.","family":"Krauss","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Harvard Medical School Boston Children's Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Roelofse","sequence":"additional","affiliation":[{"name":"Departments of Anaesthesia University of the Western Cape Stellenbosch University Tygerberg Republic of South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V. M.","family":"Yuen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Hong Kong Children's Hospital and Queen Mary Hospital University of Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Alcaino","sequence":"additional","affiliation":[{"name":"Department of Paediatric Dentistry University of Sydney Westmead Centre for Oral Health Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. S.","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Federal University of Goias Goiania\u2010Goias Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. P.","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Harvard Medical School Boston Children's Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the International Committee for the Advancement of Procedural Sedation","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1542\/peds.76.2.317","article-title":"Guidelines for the elective use of conscious sedation, deep sedation, and general anesthesia in pediatric patients","volume":"76","author":"American Academy of Pediatrics Committee on Drugs","year":"1985","journal-title":"Pediatrics"},{"key":"e_1_2_10_3_1","unstructured":"Safe Sedation Practice for Healthcare Procedures.Academy of Medical Royal Colleges.2013.https:\/\/www.rcoa.ac.uk\/system\/files\/PUB-SafeSedPrac2013.pdf(accessed 11\/08\/2019)."},{"key":"e_1_2_10_4_1","unstructured":"Royal College of Anaesthetists.Safe Sedation of Adults in the Emergency Department.2012.http:\/\/www.rcoa.ac.uk\/document-store\/safe-sedation-of-adults-the-emergency-department(accessed 11\/08\/2019)."},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0b013e3283495ba1"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13370"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001452"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-1212"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2013.10.015"},{"key":"e_1_2_10_10_1","first-page":"13","article-title":"Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016","volume":"38","author":"American Academy of Pediatric Dentistry","year":"2016","journal-title":"Pediatric Dentistry"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-2780"},{"key":"e_1_2_10_12_1","first-page":"622","article-title":"Reevaluating fasting for procedural sedation [Editorial]","volume":"172","author":"Green SM","year":"2018","journal-title":"Journal of the American Medical Association Pediatrics"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1197\/aemj.9.1.35"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.08.017"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.17226\/13058"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.09.030"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200003303421306"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68230-5"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200103013440908"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000933"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex004"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.11.030"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199301000-00010"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1986.tb02373.x"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000237296.57941.e7"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12207"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0952-8180(97)00250-X"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1996.tb04382.x"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.1999.00642.x"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer058"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2010.06331.x"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12877"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000246813.04771.03"},{"key":"e_1_2_10_34_1","first-page":"29","article-title":"Aspiration pneumonitis: fact or fiction?","volume":"2","author":"Kallar SK","year":"1988","journal-title":"Problems in Anesthesia"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1990.tb14561.x"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1996.tb05548.x"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199901000-00011"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(17)30116-9"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-018-0672-3"},{"key":"e_1_2_10_40_1","first-page":"957","article-title":"Sedation Safety Study Group of Pediatric Emergency Research Canada (PERC). Risk factors for adverse events in emergency department procedural sedation for children","volume":"171","author":"Bhatt M","year":"2017","journal-title":"Journal of the American Medical Association Pediatric"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.12472"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.15403\/jgld.2014.1121.233.kf1"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000147"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2011.04.028"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2011.05.001"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.12.011"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.06.042"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.250"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-0145"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200629070-00008"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-921192"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2371041415"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2003.07605.x"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06575-8"},{"key":"e_1_2_10_55_1","first-page":"A1183","article-title":"Sedation disasters: adverse drug reports in pediatrics\u2014FDA, USP, and others [abstract]","volume":"83","author":"Cote CJ","year":"1995","journal-title":"Anesthesiology"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.105.4.805"},{"key":"e_1_2_10_57_1","first-page":"19","article-title":"Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data","volume":"17","author":"Eisler L","year":"2018","journal-title":"Pediatric Anesthesia"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2005.07.002"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeh234"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03010747"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-2960"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0b013e328354a51a"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(16)39829-5"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4066"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.03.015"},{"key":"e_1_2_10_66_1","first-page":"678","article-title":"Association of preprocedural fasting with outcomes of emergency department sedation in children","volume":"172","author":"Bhatt M","year":"2018","journal-title":"Journal of the American Medical Association Pediatrics"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(03)00516-X"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-6723.2004.00583.x"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pec.0000186427.07636.fc"},{"key":"e_1_2_10_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2007.08.076"},{"key":"e_1_2_10_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-6723.2007.00982.x"},{"key":"e_1_2_10_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.01.033"},{"key":"e_1_2_10_73_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/81.4.522"},{"key":"e_1_2_10_74_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199307000-00034"},{"key":"e_1_2_10_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)00081-1"},{"key":"e_1_2_10_76_1","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/3914942"},{"key":"e_1_2_10_77_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001805"},{"key":"e_1_2_10_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.12458"},{"key":"e_1_2_10_79_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2010.03.1125"},{"key":"e_1_2_10_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2015.06.054"},{"key":"e_1_2_10_81_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2013-305289"},{"key":"e_1_2_10_82_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2012.06.012"},{"key":"e_1_2_10_83_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjo.2018.05.011"},{"key":"e_1_2_10_84_1","doi-asserted-by":"publisher","DOI":"10.3129\/i09-156"},{"key":"e_1_2_10_85_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/71.1.167-a"},{"key":"e_1_2_10_86_1","first-page":"339","article-title":"Nulla per os [NPO] after midnight reassessed","volume":"78","author":"Dowling JL","year":"1995","journal-title":"Rhode Island Medical Journal"},{"key":"e_1_2_10_87_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2014-0200"},{"key":"e_1_2_10_88_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3182a268d3"},{"key":"e_1_2_10_89_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181f1bd6f"},{"key":"e_1_2_10_90_1","doi-asserted-by":"publisher","DOI":"10.1067\/mje.2002.121274"},{"key":"e_1_2_10_91_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.109.2.236"},{"key":"e_1_2_10_92_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pec.0000148027.53598.b8"},{"key":"e_1_2_10_93_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.3943"},{"key":"e_1_2_10_94_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199004000-00001"},{"key":"e_1_2_10_95_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-0009"}],"updated-by":[{"DOI":"10.1111\/anae.15106","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T00:00:00Z","timestamp":1588896000000}}],"container-title":["Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fanae.14892","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.14892","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anae.14892","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.14892","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T16:47:42Z","timestamp":1761670062000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/anae.14892"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,2]]},"references-count":94,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1111\/anae.14892"],"URL":"https:\/\/doi.org\/10.1111\/anae.14892","archive":["Portico"],"relation":{},"ISSN":["0003-2409","1365-2044"],"issn-type":[{"value":"0003-2409","type":"print"},{"value":"1365-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,2]]},"assertion":[{"value":"2019-09-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-12-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}