DOI: 10.1213/ANE.0000000000002361

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PMID: 28799965

Issn Print: 0003-2999

Publication Date: 2017/10/01


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In Response

Ramon E. Abola; Tong J. Gan

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Author Information: tong.gan@stonybrookmedicine.edu

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We appreciate the comments by Drs Grocott and Brudney.1 We agree that the specific language used in medical guidelines has the potential to influence the adoption rate by anesthesiologists. In this regard, we applaud the specific language by the American Society of Enhanced Recovery, the European Society of Anaesthesiology, and the Canadian Anesthesiologists Society regarding preoperative fasting guidelines that actively encourage patients to drink clear fluids up to 2 hours before elective surgery.
We agree that guideline authors should attempt to be as explicit in their recommendations as the evidence and circumstances allow. But the final language chosen by a guideline committee must reflect a consensus opinion of the group. Thus, recommendations tend to be “watered down” and less explicit. The ambiguous nature of guidelines may also be intentional to hedge against its use during malpractice litigation.
We applaud the work by Shiraishi et al2 because it provides evidence that it is safe to allow patients to drink until 2 hours before surgery. Evidence-based research enables authors of practice guidelines to make better and more specific recommendations. The outcome data regarding the benefit of carbohydrate beverages are limited. However, allowing patients to drink clear fluid preoperatively is humane and not associated with any harm.
We challenge providers to implement process changes at their hospitals that will encourage their patients to drink clear fluids up to 2 hours before surgery. A decision support system within the electronic medical record can facilitate its implementation.
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