These fasting guidelines apply to patients ages 0 to 18 years of age receiving anesthesia care from the Department of Anesthesia, including general, regional, monitored anesthesia care, and procedural sedation. The purpose of these guidelines is:

  1. To reduce the risk of pulmonary aspiration for patients receiving anesthesia services
  2. To assist health care providers and patients in decisions about fasting intervals
  3. To be consistent with accepted standards of clinical care and evidence-based practice.

Guidelines may need to be modified by the anesthesia provider for patients with co-existing conditions (difficult airway) or conditions that might affect stomach emptying or fluid volume, such as diabetes, hiatal hernia, gastro-esophageal reflux disease (GERD), ileus or bowel obstruction, and emergency care. For patients with these conditions, risk of aspiration is greater when airway reflexes are compromised by sedative medications. These conditions may alter anesthetic management.

  • No food for eight hours before the child’s surgery (even food given through a feeding tube)
  • The child may have:
    • Formula or milk up to six hours before surgery
    • Breast milk up to four hours before surgery
    • Clear fluids up to two hours before surgery. The defining feature of a “clear fluid” is the ability to see through it and clearly read text.
  • Clear fluids are:
    • Water
    • Apple or white grape juice
    • Carbonated drinks, such as sode pop
    • Sports drinks such as Gatorade®
    • Pedialyte®
    • Clear tea
  • No milk, creamer, or lemon added to any drinks.
  • No swallowing of gum, mints, or candy.

Clear fluids should be utilized to take prescribed medications prior to surgery. Crushed medications may be administered with up to two tablespoons of plain apple jelly.

If the patient takes food in through an enteral or nasogastric tube (e.g., gastric/stomach tube, enteral/jejunostomy tube, etc.) should I observe the same fasting intervals? Yes. The patient should fast for six hours from formula/non-human milk feeds, regardless of whether the feed is via the gastric route or post-pyloric. Patients on feeding tubes should fast for four hours from breast milk feeds and for two hours from clear fluids.

What about perioperative enteral feeding in burned patients? Burned patients have special metabolic requirements because of increased caloric needs and nutritional support.

Critically Ill and Burn Elective Procedures without a cuffed endotracheal tube or cuffed tracheostomy tube in place:

  • Eight hours after all solid foods, of any volume.
  • Four hours after any non-clear beverage OR artificial enteral nutrition OR non-human milk, of any volume, and regardless if fed via gastric route or post-pyloric.
    • Non-clear beverages include orange juice (with or without pulp) or other fruit juices with pulp; smoothies; milk, cream, or creamer added to coffee or tea; and include “tube feeds” such as Promote®, Impact®, Nepro®, etc.
  • Four hours after breast milk
  • Two hours after clear fluids*, of any volume
    • Clear fluids are limited to water, apple or white grape juice, black coffee or tea (WITHOUT added milk, cream or creamer), Gatorade®, infant electrolyte solutions (Pedialyte®), carbonated beverages (Coke®, 7-Up®, etc.), plain Jello® or other gelatins without added fruits or other solids, clear, fat-free and non-turbid broth (bouillon or consommé), non-turbid clear protein beverages (Ensure Clear®, Premier Protein® Fizzique®, etc.), but do not include alcohol.
    • The defining feature of a “clear fluid” is the ability to “see through it” and clearly read text
  • NO DELAY after chewing gum, hard candy, chewing tobacco, or any other substance that is not swallowed
    • Swallowing any of these items counts as ingesting a "solid food," and may require a delay of 8 hours

A small volume (30mL / 1 ounce) of clear fluids may be utilized to take prescribed medications within two hours prior to the procedure. Crushed medications may be administered with up to two tablespoons of plain apple jelly (not apple sauce or yogurt).

Critically Ill and Burn Elective Procedures WITH a cuffed endotracheal tube or cuffed tracheostomy tube in place:

  • Four hours after artificial enteral nutrition for the following patients, regardless if fed via gastric route or post-pyloric:
    • Those who will be positioned PRONE
    • Those whose cuffed endotracheal tube or cuffed tracheostomy tube will NOT remain in place for the entire duration of the procedure (such as scheduled airway surgery, or patients for whom “attempted extubation” is planned in the operating room at the completion of the procedure).

NO DELAY after enteral feeds, of any formula or volume, for other case types, regardless if fed via gastric route or post-pyloric.

Questions? Call the Anesthesia desk at 1-319-356-2724.

Adapted and liberally paraphrased from practice guidelines by the American Society of Anesthesiologists (© 2017) and the European Society of Anesthesiology (© 2011).

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