Preoperative fasting
====================

* Eldar Søreide
* Olle Ljungqvist

In the October issue of the journal (*Can J Surg* 2005;48:409–11),1 a group of surgeons reviewed the recent Cochrane analysis2 on preoperative fasting in adults to prevent perioperative complications. They agreed that the intake of clear oral liquids 2–3 hours preoperatively improved patient well-being. Despite these facts, their impression is that in North America, a fast of nil by mouth (NPO) after midnight remains standard practice in most institutions. Furthermore, they argued against the modern guidelines, stating that the old “NPO after midnight routine” allowed “the greatest flexibility to the operative team.” We challenge this statement and propose that this fear of perioperative complications is unsubstantiated. It is our experience that changing to modern fasting guidelines very rarely causes problems during induction of anesthesia. The change of guidelines generates better communication between the operating room and the ward where the patient is waiting. This practice has in many cases improved patient flow through the system. A recent survey of daily practice from 5 countries in Europe, where many hospitals follow modern fasting guidelines, strongly suggests that this works in daily practice.3 As commented in an editorial accompanying this paper, it is likely to be much more worthwhile to spend time implementing modern care than producing yet another study showing improved therapy that will not be used in daily practice.4

## Footnotes

*   **Competing interests:** None declared.

## References

1.  McLeod R, Fitzgerald W, Sarr M for Members of the Evidence Based Reviews in Surgery Group. Canadian Association of General Surgeons and American College of Surgeons evidence based reviews in surgery. 14. Preoperative fasting for adults to prevent perioperative complications. Can J Surg 2005;48:409–11.
    
    

2.  Brady M, Kinns SP. Preoperative fasting for adults to prevent perioperative complications [Cochrane review]. In: The Cochrane Library; Issue 4, 2003. Oxford: Update Software.
    
    

3.  Lassen K, Hannemann P, Ljungqvist O, et al. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ 2005; 330:1420–1.
    
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4.  Urbach DR, Baxter NN. Reducing variation in surgical care. BMJ 2005;330: 1401–2.
    
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