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Background and Aims Preoperative fasting partially mitigates against pulmonary aspiration following anaesthesia. International guidelines specify fasting periods of 6-8 hours for food and 2 hours for clear fluid prior to all surgeries, including caesarean delivery (CD). Prolonged fasting has deleterious effects and contemporary anaesthesia practice has evolved towards reduced fasting times for CD via liberal drinking regimes, including ‘Sip Til Send’. Our primary aim was to compare standard fasting against ‘Sip Til Send’ using gastric ultrasound in a paired cohort non-inferiority study using a pragmatic study design.
Methods Fully fasted parturients due to undergo elective CD under neuraxial anaesthesia were recruited and commenced on ‘Sip Til Send’ fasting before surgery. Qualitative and quantitative gastric ultrasounds were performed via a standardised approach following recruitment and prior to induction of anaesthesia.
Results 69 patients were assessed for eligibility and 55 recruited. Analysis was incomplete on two scans due to artefact impeding interpretability. The mean ‘Sip Til Send’ fasting time was 192.6 ± 108.7 minutes, with participants drinking a mean of 113.7 ± 70.4 ml.hr-1. Notably, seven participants drank more than the suggested 170 ml.hr-1. There were no statistical differences between groups (table 1). Estimation of gastric content volume yielded 3 and 5 parturients with gastric contents greater than 1.5ml.kg-1 in the fully fasted and ‘Sip Til Send’ fasted states, respectively.
Conclusions ‘Sip Til Send’ fasting with water was non-inferior to a standard fasting protocol as tested in a pragmatic hospital setting. Therefore, it should be considered for elective CD and may prove beneficial in other areas of anaesthesia.
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