The effect of a small drink. The literature contains a single randomized controlled trial. Table 3. The amount of time you have to go without food or drink (fast) before you have your operation will depend on the type of operation you're having. Anesth Analg 1992; 74:694–7, Schreiner MS, Triebwasser A, Keon TP: Ingestion of liquids compared with preoperative fasting in pediatric outpatients. August 3, 2015 | By Staff Writer They also strongly agree that patients should be informed of fasting requirements, and the reasons for them, sufficiently in advance of their procedures. , pneumonitis). The Royal College of Nursing guidelines state a minimum fasting period of six hours for food and two hours for clear fluids, prior to elective anaesthesia or sedation in healthy patients. 4. When stomach contents enter the airway, aspiration occurs. No identified studies address the specified relationships among interventions and outcomes. , length of stay in hospital, costs). Br J Anaesth 1988; 60:803–5, Phillips S, Hutchinson S, Davidson T: Preoperative drinking does not affect gastric contents. , meta-analysis). Plain apple jelly can be used to take crushed pills up to 2 hours before a procedure. Children have frequently been fasting longer than necessary before anaesthesia. Additional fasting time (e.g. Br J Anaesth 1993; 70:6–9, Read MS, Vaughan RS: Allowing pre-operative patients to drink: Effects on patients' safety and comfort of unlimited oral water until 2 hours before anaesthesia. The consultants agree and the ASA members strongly agree that for children and adults, fasting from the intake of nonhuman milk 6 h or more before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e. , monitored anesthesia care) in patients who have no apparent increased risk for pulmonary aspiration. Similarly, when the combined drugs are compared to gastrointestinal stimulants alone as the single-drug comparison, equivocal findings for gastric volume are reported.28,30–32,66–68Randomized controlled trials comparing other drug combinations versus  single drugs alone report inconsistent findings regarding gastric volume and pH outcomes (Category C2 evidence ).29,57,65,69–71. For the literature review, potentially relevant clinical studies were identified via  electronic and manual searches of the literature. , toast and a clear liquid) 6 h or more before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e. Feedings should stop at the first sign of higher stomach residual volumes. Airway management techniques that are intended to reduce the occurrence of pulmonary aspiration are not the focus of these Guidelines. Anesth Analg 1984; 63:40–6, Dimich I, Katende R, Singh PP, Mikula S, Sonnenklar N: The effects of intravenous cimetidine and metoclopramide on gastric pH and volume in outpatients. Can J Anaesth 1987; 34:560–2, Hutchinson BR: Preoperative magnesium trisilicate in infants. The risk of aspiration must be weighed against the risk of not having surgery in a timely manner. , cimetidine, ranitidine, famotidine), Proton pump inhibitors (e.g. They also may serve as a resource for other health care professionals who advise or care for patients who receive anesthesia care during procedures. DerSimonian-Laird random-effects odds ratios are obtained when significant heterogeneity is found (P < 0.01). Level 3 contains one relationship of interest to the Guidelines (i.e. The consultants agree and the ASA members strongly agree that for otherwise healthy neonates (younger than 44 gestational weeks) and infants, fasting from the intake of breast milk at least 4 h before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e. Strongly Disagree. Because nonhuman milk is similar to solids in gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period. Therefore, these Guidelines focus on assessing the causal relationship between a preoperative intervention and the frequency of pulmonary aspiration, and assessing the causal relationship between a preoperative intervention and the frequency or severity of an adverse consequence associated with aspiration (e.g. Although some outcomes (e.g. Can J Anaesth 1987; 34:117–21, Yagci G, Can MF, Ozturk E, Dag B, Ozgurtas T, Cosar A, Tufan T: Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: A randomized, controlled trial. PRACTICE Guidelines  are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. Can Anaesth Soc J 1981; 28:29–32, Henderson JM, Spence DG, Clarke WN, Bonn GG, Noel LP: Sodium citrate in paediatric outpatients. Because worse outcomes may be associated with aspiration of particulate matter, acidic contents, or large volumes of any gastric content, guidelines aim to eliminate particulate matter and decrease the volume and acidity of these contents at the time of induction of anesthesia [ 3 ]. The available literature cannot be used to assess relationships among clinical interventions and clinical outcomes. Level 2 represents a comparison in which one step, or intermediate outcome, exists between the intervention and the outcome of interest. Anesth Analg 2000; 90:717–21, O'Connor TA, Basak J, Parker S: The effect of three different ranitidine dosage regimens on reducing gastric acidity and volume in ambulatory surgical patients. In the studies reviewed with first-order comparisons, the relationship between one of the identified interventions in the Guidelines and the incidence of pulmonary aspiration was not assessed. Following the Guidelines does not guarantee complete gastric emptying. They are based on research and expert opinion. Solid or semi-solid food in the stomach may not let your lungs get air. Anesth Analg 1984; 63:903–10, Manchikanti L, Grow JB, Colliver JA, Hadley CH, Hohlbein LJ: Bicitra (sodium citrate) and metoclopramide in outpatient anesthesia for prophylaxis against aspiration pneumonitis. Can Anaesth Soc J 1986; 33:336–44, Warner MA, Warner ME, Weber JG: Clinical significance of pulmonary aspiration during the perioperative period. The protocol for reporting each source of evidence is described below. The literature is insufficient to evaluate the effect of administering gastrointestinal stimulants on the perioperative incidence of emesis/reflux or pulmonary aspiration (Category D evidence ). For example, a rapid-sequence induction/tracheal intubation technique or an awake tracheal intubation technique may be useful to prevent this problem during the delivery of anesthesia care. For these guidelines, preoperative fasting is defined as a prescribed period of time before a procedure when patients are not allowed the oral intake of liquids or solids. … Level 2. The risk of aspiration must be weighed against the risk of not having surgery quickly. Anaesthesia 1999; 54:51–9, van der Walt JH, Foate JA, Murrell D, Jacob R, Bentley M: A study of preoperative fasting in infants aged less than three months. J Indian Med Assoc 1997; 95:166–8, Maekawa N, Mikawa K, Yaku H, Nishina K, Obara H: Effects of 2-, 4- and 12-hour fasting intervals on preoperative gastric fluid pH and volume, and plasma glucose and lipid homeostasis in children. The literature contains noncomparative observational studies with associative (e.g. Table 1indicates that outcomes related to preoperative fasting and the administration of pharmacologic agents were insufficient to evaluate cause-and-effect relationships that link the interventions of interest in these Guidelines with the occurrence of pulmonary aspiration or the clinical consequences from pulmonary aspiration. Your stomach must be empty for your procedure. Complications of aspiration include, but are not limited to, aspiration pneumonia, respiratory disabilities, and related morbidities. First, they reached consensus on the criteria for evidence. Preoperative fasting is the practice of a patient abstaining from oral food and fluid intake for a time before an operation is performed. Randomized placebo-controlled trials indicate that famotidine is effective in reducing gastric volume and acidity (Category A2 evidence ).39,44,45, Proton pump inhibitors : Randomized controlled trials support the efficacy of omeprazole in reducing gastric volume and acidity (Category A2 evidence ),41,46–48with similar findings reported for lansoprazole (Category A2 evidence ).41,42,49,50. The consultants agree and the ASA members strongly agree that fasting from the intake of a light meal (e.g. AANA J 1989; 57:238–43, Morison DH, Dunn GL, Fargas-Babjak AM, Moudgil GC, Smedstad K, Woo J: A double-blind comparison of cimetidine and ranitidine as prophylaxis against gastric aspiration syndrome. Before you go on a new diet, particularly one that involves fasting, ask your doctor if it's a good choice for you. J Clin Anesth 1991; 3:40–4, Gipson SL, Stovall TG, Elkins TE, Crumrine RS: Pharmacologic reduction of the risk of aspiration. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. The anticipated time increase for these two respondents was 5 and 120 min, respectively. Two respondents reported that the Guidelines would increase the amount of time spent per case. Subject Headings “surgery”, “operative” “fasting” and “clinical practice guideline” or “systematic review” or “meta-analysis”. Examples of clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. Unless told differently by your doctor, do not eat food for 8 hours before your procedure (even food or formula given through a feeding tube). , cohort, case-control research designs) of clinical interventions or conditions and indicates statistically significant differences between clinical interventions for a specified clinical outcome. • lear liquids‡ -- -Stop 2 hours prior to procedure • reast milk------- Stop 4 hours prior to procedure • Infant formula--- Stop 6 hours prior to procedure • Nonhuman milk- Stop 6 hours prior to procedure • Light meal** ---- Stop 6 hours prior to procedure • Fried foods, fatty foods, or meat- Additional fasting time … New opinion surveys were developed to address each clinical intervention identified in the document, and identical surveys were distributed to both expert consultants and a random sample of active ASA members. Can J Anaesth 1995; 42:467–72, Foulkes E, Jenkins LC: A comparative evaluation of cimetidine and sodium citrate to decrease gastric acidity: Effectiveness at the time of induction of anaesthesia. Level 1. Anesthesia care during procedures refers to general anesthesia, regional anesthesia, or sedation/analgesia (i.e. Clear, see-through liquids include: Water. A randomized controlled trial comparing a light breakfast consumed an average of less than 4 h before a procedure with overnight fasting reports equivocal findings regarding gastric volume and pH levels for adults (Category C2 evidence ).24Studies with nonrandomized comparative findings for children given nonhuman milk 4 h or less before a procedure versu  s children who fasted for more than 4 h report higher gastric volumes (Category B2 evidence ) and equivocal gastric pH (Category C3 evidence ).21,25,26A study with observational findings suggests that fasting for more than 8 h may be associated with hypoglycemia in children (Category B2 evidence ).26The literature is insufficient to evaluate the effect of the timing of ingestion of solids and nonhuman milk and the perioperative incidence of emesis/reflux or pulmonary aspiration (Category D evidence ). We do not want food from your stomach to get into your lungs. People who have residual volumes checked, can stop feeds 4 hours before the procedure if these volumes are not going up. American Society of Anesthesiologists Fasting Recommendations*. Throughout these Guidelines, preoperative should be considered synonymous with preprocedural, as the latter term is often used to describe procedures that are not considered operations. Level 2. Meta-analysis of randomized controlled trials3–10comparing fasting times of 2–4 h versus  more than 4 h report smaller gastric volumes and higher gastric pH values in adult patients given clear liquids 2–4 h before a procedure (Category A1 evidence ); findings for gastric pH values more than 2.5 are equivocal (Category C1 evidence ).3–7,9Meta-analysis of randomized controlled trials11–19report higher gastric pH values (Category A1 evidence ) and equivocal findings regarding differences in gastric volume for children given clear liquids 2–4 h before a procedure versus  fasting for more than 4 h before a procedure (Category C1 evidence ).11–19Ingested volumes of clear liquids in the above studies range from 100 ml to unrestricted amounts for adults, and 2 ml/kg to unrestricted amounts for children. The literature either does not meet the criteria for content as defined in the “Focus” of the Guidelines or does not permit a clear interpretation of findings due to methodological concerns (e.g. Therefore, a cause-and-effect relationship between an intervention of interest and pulmonary aspiration cannot be shown. The literature contains observational comparisons (e.g. , metoclopramide, cisapride), Histamine-2 receptor antagonists (e.g. For these guidelines, preoperative fasting is defined as a pre-scribed period of time before a procedure when patients are not allowed the oral intake of liquids or solids. Can J Anaesth 1990; 37:498–501, Splinter WM, Schaefer JD: Ingestion of clear fluids is safe for adolescents up to 3 h before anaesthesia. Anaesth Intensive Care 1990; 18:527–31, Cook-Sather SD, Harris KA, Chiavacci R, Gallagher PR, Schreiner MS: A liberalized fasting guideline for formula-fed infants does not increase average gastric fluid volume before elective surgery. Consensus was obtained from multiple sources, including: (1) survey opinion from consultants who were selected based on their knowledge or expertise in preoperative fasting and prevention of pulmonary aspiration, (2) survey opinions solicited from active members of the American Society of Anesthesiologists, (3) testimony from attendees of a publicly held open forum for the original Guidelines held at a national anesthesia meeting, (4) Internet commentary, and (5) Task Force opinion and interpretation. The consultants and ASA members both strongly agree that only nonparticulate antacids should be used when antacids are indicated for selected patients. Anaesth Intens Care 1980; 8:464–8, Andrews AD, Brock-Utne JG, Downing JW: Protection against pulmonary acid aspiration with ranitidine. , thirst, hunger, nausea, vomiting), adverse outcomes (e.g. In addition, both the consultants and ASA members strongly agree that verification of patient compliance with fasting requirements should be assessed at the time of the procedure. Fourth, the Task Force held open forums at a national meeting†to solicit input on the draft recommendations. Nutrition 2008; 24:212–6, Gombar S, Dureja J, Kiran S, Gombar K, Chhabra B: The effect of pre-operative intake of oral water and ranitidine on gastric fluid volume and pH in children undergoing elective surgery. This has been the standard rule of thumb promoted by anesthesiologists, surgeons, doctors and other healthcare providers for at least the last few decades. Level 4 contains the other relationship of interest to the Guidelines (i.e. Open-forum testimony, Internet-based comments, letters, and editorials were all informally evaluated and discussed during the development of the original Guideline recommendations. Br J Anaesth 1987; 59:678–82, Thomas DK: Hypoglycaemia in children before operation: Its incidence and prevention. Br J Anaesth 1989; 63:536–40, Gouda BB, Lydon AM, Badhe A, Shorten GD: A comparison of the effects of ranitidine and omeprazole on volume and pH of gastric contents in elective surgical patients. , monitored anesthesia care) should be maintained. Fasting prior to anaesthesia minimizes the risk of aspirating stomach contents into the lungs. Apple juice is an approved clear fluid. Randomized controlled trials indicate that, when histamine-2 receptor antagonists (i.e. , level 1, 2, or 3 within category A, B, or C) is included in the summary. Median score of 3 (at least 50% of responses are 3—or no other response category or combination of similar categories contain at least 50% of responses). Randomized controlled trials report statistically significant (P < 0.01) differences between clinical interventions for a specified clinical outcome. To control for potential publishing bias, a “fail-safe n value” is calculated. The purpose of fasting guidelines is to minimize the volume of stomach contents. Level 3. Br J Anaesth 1995; 74:614–5, Mikawa K, Nishina K, Maekawa N, Asano M, Obara H: Lansoprazole reduces preoperative gastric fluid acidity and volume in children. J Clin Anesth 1990; 2:301–5, Nicolson SC, Dorsey AT, Schreiner MS: Shortened preanesthetic fasting interval in pediatric cardiac surgical patients. , monitored anesthesia care) should be maintained. Acta Anaesth Scan 1992; 36:513–5, Hett DA, Scott RC, Risdall JE: Lansoprazole in the prophylaxis of acid aspiration during elective surgery. Meta-analysis of double-blind randomized placebo-controlled trials35,38–43also supports the efficacy of ranitidine to reduce gastric volume and acidity during the perioperative period (Category A1 evidence ). A procedure should not be cancelled or delayed because a person is chewing gum or sucking hard candy. Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. Fifth, expert consultants were surveyed to assess their opinions on the feasibility of implementing the Guidelines. These Guidelines may not apply to, or may need to be modified for (1) patients with coexisting diseases or conditions that can affect gastric emptying or fluid volume (e.g. Fasting (not eating or drinking) keeps your stomach empty. The ASA members disagree and the consultants strongly disagree that preoperative anticholinergics should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e. Do not use pudding or apple sauce. Can J Anaesth 1995; 42:277–80, Sjövall S, Kanto J, Iisalo E, Kangas L, Mansikka M, Pihlajamäki K: Use of atropine in connection with oral midazolam premedication. Eur J Anaesthesiol 1987;4:149–53, Gonzalez ER, Kallar SK, Dunnavant BW: Single-dose intravenous H2 blocker prophylaxis against aspiration pneumonitis: Assessment of drug concentration in gastric aspirate. You may drink clear fluids until 2 hours before your procedure if your doctor approves. Acta Anaesthesiol Scand 1993; 37:783–7, Miller BR, Tharp JA, Issacs WB: Gastric residual volume in infants and children following a 3-hour fast. The routine preoperative use of medications that block gastric acid secretion to decrease the risks of pulmonary aspiration in patients who have no apparent increased risk for pulmonary aspiration is not recommended. You'll be told how long you must not eat or drink for before your operation. Is a 4-hour fast necessary? Our protective reflexes slow down when we are given anesthesia. Anaesthesia 1986; 41:486–92, Solanki DR, Suresh M, Ethridge HC: The effects of intravenous cimetidine and metoclopramide on gastric volume and pH. Fasting guidelines are not meant to be the final decision. The purposes of these Guidelines are to (1) enhance the quality and efficiency of anesthesia care, (2) stimulate evaluation of clinical practices, and (3) reduce the severity of complications related to perioperative pulmonary aspiration of gastric contents. It is appropriate to fast from intake of breast milk at least 4 h before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e. Randomized controlled trials indicate that preoperative antacids (e.g. Br J Anaesth 1974; 46:66–8, Jellish WS, Kartha V, Fluder E, Slogoff S: Effect of metoclopramide on gastric fluid volumes in diabetic patients who have fasted before elective surgery. The consultants and ASA members both disagree that preoperative antiemetics should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e. , survey data, open-forum testimony, Internet-based comments, letters, editorials) was considered in the development of the original Guidelines. Patients should be informed of fasting requirements, and the reasons for them, sufficiently in advance of their procedures. For these Guidelines, preoperative fasting is defined as a prescribed period of time before a procedure when patients are not allowed the oral intake of liquids or solids. Learn more about this online health care resource. Acta Anaesthesiol Belg 1993; 44:3–10, McKenzie R, Sharifi-Azad S, Dershwitz M, Miguel R, Joslyn AF, Tantisira B, Rosenblum F, Rosow CE, Downs JB, Bowie JR: A randomized, double-blind pilot study examining the use of intravenous ondansetron in the prevention of postoperative nausea and vomiting in female inpatients. Aspiration can happen when food or liquids from our stomach get in our airway. Ninety-six percent of respondents indicated that the Guidelines would have no effect on the amount of time spent on a typical case. The Task Force developed the original Guidelines by means of a six-step process. , cimetidine, ranitidine) are combined with gastrointestinal stimulants (i.e. A comparison of ondansetron, droperidol, metoclopramide and placebo. The routine preoperative use of multiple agents in patients who have no apparent increased risk for pulmonary aspiration is not recommended. Anesthesiology 1993; 78:56–62, Agarwal A, Chari P, Singh H: Fluid deprivation before operation. No controlled trials were found that address the impact of conducting a preoperative assessment (e.g. These Guidelines do not apply to patients who undergo procedures with no anesthesia or only local anesthesia when upper airway protective reflexes are not impaired, and when no risk factors for pulmonary aspiration are apparent. Because nonhuman milk is similar to solids in gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period. Disagree. When the fasting recommendations in these Guidelines are not followed, the practitioner should compare the risks and benefits of proceeding, with consideration given to the amount and type of liquids or solids ingested. Observational studies report inconsistent findings or do not permit inference of beneficial or harmful relationships. The literature is categorized according to the proximity or directness of the outcome to the intervention. For the original Guidelines, interobserver agreement among Task Force members and two methodologists was established by interrater reliability testing. Anesth Analg 1984; 63:841–3, This site uses cookies. , pregnancy, obesity, diabetes, hiatal hernia, gastroesophageal reflux disease, ileus or bowel obstruction, emergency care, enteral tube feeding) and (2) patients in whom airway management might be difficult. These authors should be commended for providing further evidence of the safety of oral hydration 2 hours before surgery. It is appropriate to fast from intake of clear liquids at least 2 h before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e. The number of studies is insufficient to conduct meta-analysis, and (1) randomized controlled trials have not found significant differences among groups or conditions, or (2) randomized controlled trials report inconsistent findings. , monitored anesthesia care) should be maintained. These values represent moderate to high levels of agreement. 6 hours before your procedure Do not drink non-clear fluids, such as milk, hot chocolate, or coffee or tea with milk, cream, or nondairy creamer, for 6 hours before your procedure. , 8 h or more) may be needed in these cases. , monitored anesthesia care) in patients who have no apparent increased risk for pulmonary aspiration. General variance-based effect-size estimates or combined probability tests are obtained for continuous outcome measures. Anesth Analg 1989; 68:541–4, Enoki T, Hatano Y, Tsujimura Y, Nomura R: Attenuation of gastric effects of famotidine by preoperative administration of intravenous fluids. Survey responses from active ASA members are reported in summary form in the text. , monitored anesthesia care) in patients who have no apparent risk for pulmonary aspiration. , monitored anesthesia care) should be maintained. A new histamine H2-receptor antagonist. operative fasting and carb loading (as appropriate) before their surgery. These Guidelines are also not intended for women in labor. Randomized controlled trials indicate that the preoperative administration of droperidol55–57and ondansetron58–60are effective in reducing nausea and vomiting during the period after surgery (Category A2 evidence ). Anesth Analg 1986; 65:1112–6, McGrady EM, Macdonald AG: Effect of the preoperative administration of water on gastric volume and pH. Do not swallow gum or hard candy. The routine preoperative use of gastrointestinal stimulants to decrease the risk of pulmonary aspiration in patients who have no apparent increased risk for pulmonary aspiration is not recommended. Equivocal. , monitored anesthesia care) should be maintained. Additional Pre-Surgery Instructions Fasting is just one of many instructions that appear on a patient's pre-operative preparation list. Part I: Coffee or orange juice versus overnight fast. Meta-analysis was limited to gastric volume and acidity outcomes (table 2). Do not drink non-clear fluids, such as milk, hot chocolate, or coffee or tea with milk, cream, or nondairy creamer, for 6 hours before your procedure. The fasting periods noted above apply to patients of all ages. Anesth Analg 1996; 82:832–6, Nishina K, Mikawa K, Takao Y, Shiga M, Maekawa N, Obara H: A comparison of rabeprazole, lansoprazole, and ranitidine for improving preoperative gastric fluid property in adults undergoing elective surgery. No search for unpublished studies was conducted; no reliability tests for locating research results were done. Abstaining from food before surgery depletes the body, just when it needs maximum resources to withstand the surgery itself. , diabetes mellitus) that may increase the risk of regurgitation and pulmonary aspiration. Anaesthesia 1982; 37:22–5, Escolano F, Castaño J, Pares N, Bisbe E, Monterde J: Comparison of the effects of famotidine and ranitidine on gastric secretion in patients undergoing elective surgery. Br J Anaesth 1983; 55:1185–8, Meakin G, Dingwall AE, Addison GM: Effects of fasting and oral premedication on the pH and volume of gastric aspirate in children. Levels 2 through 4 represent comparisons that must first control for an intermediate outcome. Experts Have Changed Pre-surgical Fasting Recommendations In 1999 and again this year, the American Society of Anesthesiologists (ASA) issued new guidelines from its Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of … For these Guidelines, the primary outcomes of interest are pulmonary aspiration and its adverse consequences. Continuous duodenal feedings have less risk of aspiration than stomach feedings. Enhancements in the quality and efficiency of anesthesia care include, but are not limited to, the cost-effective use of perioperative preventive medication, increased patient satisfaction, avoidance of delays and cancellations, decreased risk of dehydration or hypoglycemia from prolonged fasting, and the minimization of perioperative morbidity. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration Of 5 ( at least one of the independent studies are conducted to ensure consistency among study results JM Hatton. Results whenever both types of analytic relationships between preoperative interventions and outcomes of and! Are beneficial or harmful relationships among clinical interventions and clinical consequences from aspiration. The summary were reviewed and evaluated evaluated and discussed during the development of the preoperative administration of water on physiology., atropine, glycopyrrolate ), table 4 designs and statistical information to conduct analysis... 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