ReviewBJA open2024
Preoperative fasting and the risk of pulmonary aspiration-a narrative review of historical concepts, physiological effects, and new perspectives.
Review in BJA open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Peri-operative fasting in adults: an international, multidisciplinary consensus statement.Anaesthesia · 2026Pooled it
- Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement.British journal of anaesthesia · 2025Pooled it
- Simethicone dosages with minimal normal saline solution volume to enhance mucosal visualization in upper endoscopy: a multicenter, randomized, double-blind, placebo-controlled trial.Scientific reports · 2025Trial
- [Perioperative management of trochanteric femoral fractures : Fasting, fluid therapy and multimodal pain management as underappreciated factors].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- Korean consensus-based recommendations for preanesthetic gastric ultrasound and anesthetic considerations for GLP-1 receptor agonist-based therapy: a consensus statement from Clinical Practice Guideline Committee of the Korean Society of Anesthesiologists.Korean journal of anesthesiology · 2026Review
- Unrestricted drinking before procedural sedation using fasting cards: a prospective observational quality improvement study.iGIE : innovation, investigation and insights · 2026Article
- Article
- 2026 ESAIC Guidelines on preoperative fasting in adults: clinical practice guidelines protocol with EAES participation.European journal of anaesthesiology and intensive care · 2026Article
- Comment on Peng et al. "Gastric ultrasound assessment of gastric volume and related factors in patients undergoing gastrointestinal endoscopy under sedation".Journal of anesthesia · 2026Article
- Impact of Shorter Preoperative Fluid Fasting on Patient Outcomes: A Safe Brain Initiative Retrospective Cohort Analysis.Anesthesia and analgesia · 2026Observational
- True Preoperative Liquid Fasting in Romania-A Secondary Analysis of the Thirst Study.Nutrients · 2026Observational
- Implementation of the 'Countdown to Theatre' Approach to Bridge the Evidence-Practice Gap in Paediatric Preoperative Fasting: A Quality Improvement Initiative.Journal of advanced nursing · 2026Article
- Glucagon-like Peptide-1 Receptor Agonists and Risk of Pneumonia and Postprocedure Hospitalization Among Patients Undergoing Gastrointestinal Endoscopy.Gastro hep advances · 2026Article
- Outcomes of Intravenous Normal Saline Infusion Pre-Cardiac Implantable Electronic Devices Versus No Infusion in Fasting.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026Article
- Increased incidence of gastric food retention during endoscopic retrograde cholangiopancreatography in liver transplant recipients: A retrospective cohort study.World journal of transplantation · 2025Article
- Breaking with tradition: perioperative care without fasting or medication changes for diabetic foot surgery.Die Anaesthesiologie · 2025Article
- Development and implementation of a multifaceted strategy to reduce excessive fasting in an acute surgical setting using the behavior change wheel framework.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2025Article
- Gastric ultrasound: Enhancing preoperative risk assessment and patient safety.Journal of perioperative practice · 2025Article
- Identification of intraoperative hypotension endotypes and revolution with a temporal deep learning algorithm.Perioperative medicine (London, England) · 2025Article
- The safety and effect of preoperative reduced fasting time by oral clear liquid administration in adult surgery patients: a randomized controlled trial.Annals of surgical treatment and research · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In the early days of anaesthesia, the fasting period for liquids was kept short. By the mid-20th century 'nil by mouth after midnight' had become routine as the principles of the management of 'full stomach' emergencies were extended to include elective healthy patients. Back then, no distinction was made between the withholding of liquids and solids. Towards the end of the last century, recommendations of professional anaesthesiology bodies began to reduce the fasting time of clear liquids to 2 h. This reduction in fasting time was based on the understanding that gastric emptying of clear liquids is rapid, exponential, and proportional to the current filling state of the stomach. Furthermore, there was no evidence of a link between drinking clear liquids and the risk of aspiration. Indeed, most instances of aspiration are caused by failure to identify aspiration risk factors and adjust the anaesthetic technique accordingly. In contrast, long periods of liquid withdrawal cause discomfort and may also lead to serious postoperative complications. Despite this, more than two decades after the introduction of the 2 h limit, patients still fast for a median of up to 12 h before anaesthesia, mainly because of organisational issues. Therefore, some hospitals have decided to allow patients to drink clear liquids within 2 h of induction of anaesthesia. Well-designed clinical trials should investigate whether these concepts are safe in patients scheduled for anaesthesia or procedural sedation, focusing on both aspiration risk and complications of prolonged fasting.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.