Fasting

Question 1

What are the pre-operative fasting recommendations

Answer 1

Light meals, formula and milk drinks 6hrs
Breast milk 4hrs
Water 2hrs

Question 2

Which patients are at increased risk of aspiration

Answer 2

Unfasted
Dec lower oesophageal sphincter tone (pregnancy, hiatus hernia, GORD)
Inc intra-abdominal pressure (obesity, pregnancy)
Delayed gastric emptying (diabetes, pyloric stenosis, opioids, GIT obstruction, ileus, trauma)
Dec level of consciousness

Question 3

What measures can decrease risk of pulmonary aspiration of stomach contents

Answer 3

Fasting
Chemical control of gastric acidity and volume
RSI with cricoid (controversial)
Suction on and available
Experienced assistance during intubation
NGT/OGT

Question 4

What chemical control of gastric contents are available

Answer 4

Inc gastric emptying - prokinetics (Metoclopramide
Decrease acidity - PPIs and H2 receptor antagonists (Ranitidine, Esomeprazole etc)
Neutralize acidity - Sodium citrate

Question 5

What are the recommendations for H2 blockers/PPIs

Answer 5

For use in high risk patients
Ideally need to be given the night before OT and a second dose 2hrs pre-op
Ideal for patients with severe GORD/Waterbrash symptoms