Yes, it is settled. Its the consensus of the ASA and other major organizations. Disagree all you want but the fact remains that the ASA supports it. As does the huge amount of literature that also supports it. Those are the facts.
Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018 | Anesthesiology | American Society of Anesthesiologists (asahq.org)
The consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendations to (1) consult with a medical specialist, when appropriate, before administration of moderate procedural sedation to patients with significant underlying conditions; (2) when feasible before the procedure, inform patients or legal guardians of the benefits, risks, and limitations of moderate sedation/analgesia and possible alternatives, and elicit their preferences; (3) before the day of the procedure, inform patients or legal guardians that they should not drink fluids or eat solid foods for a sufficient period of time to allow for gastric emptying; and (4) on the day of the procedure, assess the time and nature of the last oral intake. All four groups of survey respondents agreed with the recommendation that in urgent or emergent situations where complete gastric emptying is not possible, do not delay moderate procedural sedation based on fasting time alone.
This guideline has been organized by the American College of Emergency Physicians and has been endorsed by the American Academy of Emergency Medicine, the American Board of Emergency Medicine, the American College of Cardiology, the American College of Medical Toxicology, the American College of Osteopathic Emergency Medicine, the Association of Academic Chairs of Emergency Medicine, the Emergency Medicine Residents’ Association, the Emergency Nurses Association, the Society for Academic Emergency Medicine, and the Society for Pediatric Sedation
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To date, only nine reports of aspiration-associated deaths have been reported in the post-1984 procedural sedation literature, of which eight were during upper gastrointestinal endoscopy. None of these occurred in children or in healthy adults.66 Currently, there is no evidence that non-compliance with elective fasting guidelines increases the risk of aspiration or other adverse events.23-31 Any concerns regarding aspiration vastly exceed the actual risk.31,66-69
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́ Providers of unscheduled procedural sedation should assess the timing and nature of recent oral intake. The urgency of the procedure will dictate the necessity of providing sedation without delay, regardless of fasting status. For patients with established risk factors for aspiration (eg, serious underlying illness,31,66 obstructive sleep apnea,31 obesity,70-73 age less than 12 months,31 upper endoscopy as the procedure,37,38,66,74,75 or bowel obstruction),31 consider the risks versus benefits of delaying procedural sedation after recent ingestion of a substantial meal. When such a delay is not feasible, consider the use of dissociative sedation, as unlike other sedatives ketamine helps preserve protective airway reflexes,5,32 and there have been no reported occurrences of aspiration (despite its association with vomiting and laryngospasm) in patients receiving this agent alone except in compromised neonates.5,66
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The search yielded 2,046 titles for review.
́ Fifty-five articles were eligible, including 9,652 procedural sedations.
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́ Severe adverse events requiring emergent medical intervention were rare, with one case of aspiration in 2,370 sedations (1.2 per 1,000), one case of laryngospasm in 883 sedations (4.2 per 1,000), and two intubations in 3,636 sedations (1.6 per 1,000).
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755 157/ |
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Studies
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́ A prospective observational trial looking at 1014 children undergoing procedural sedation in the ED, of whom 905 had data on fasting status available. More than half the patients (509) did not meeting fasting guidelines.
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́ There was no difference in adverse events between the fasting and non- fasting groups. There was no difference in vomiting between the fasting and non-fasting groups. There were no cases of aspiration.
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Agrawal D, Manzi SF, Gupta R, Krauss B. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Annals of emergency medicine. 2003; 42(5):636-46. PMID: 14581915
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