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An exploration of pre-operative fasting practices in adult patients having elective surgery

09 April 2020
15 min read
Volume 29 · Issue 7



Patients fast routinely before elective surgery in order to reduce gastric volume and acidity. The standard fasting time is ‘nil by mouth’ from midnight before surgery. In recent years, new guidelines have recommended that patients remain nil by mouth from clear fluids for 2 hours and from solids for 6 hours. This literature review explored preoperative fasting practices in adult patients from an international perspective.


A literature search was undertaken of databases, including CINAHL Plus, PubMed, Medline, the Cochrane Central Register of Controlled Trials, Science Direct, Sage Journals and Embase.


Anaesthetists were found to possess greater knowledge of reduced preoperative fasting than other health professionals including nurses.


Actual fasting time was found to be relatively longer than prescribed fasting times.

Fasting is the act of refraining from food or drinks for a specific purpose. This could be due to religious or personal reasons, but could also be due to requirements for certain activities such as undergoing elective surgery. According to Mathews et al (2013), preoperative fasting, originated with Lister (1883), who suggested that it was desirable for no solid food to be in the stomach when chloroform was given and that it was beneficial to give a cup of tea about 2 hours prior to surgery. Mendelson (1946) further discovered that vomiting during induction of anaesthesia brought about respiratory distress, resulting from pulmonary aspiration of gastric hydrochloric acid. This discovery led to the common practice of ‘nil by mouth’ from midnight before surgery (Mathews et al, 2013).

Today, this is a common practice observed in the clinical environment: if procedures are scheduled for the morning, patients are required to fast from 12 midnight the night before. This preoperative fasting policy was perceived to be easy to administer and enable alterations in the theatre list (Brady et al, 2003).

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