Determinants of liquid gastric emptying: comparisons between milk and isocalorically adjusted clear fluids. V 114 No 3 495 March 2011 Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the . When available, Category A evidence is given precedence over Category B evidence for any particular outcome. They also may serve as a resource for other health care professionals who advise or care for patients who receive anesthesia care during procedures. For findings to be accepted as significant, odds ratios must agree with combined test results whenever both types of data were assessed. When relevant, decision-informative, and practicable, pairwise and network random-effects meta-analyses of randomized controlled trials were conducted.10,11 Nonrandomized studies were considered in the assessment of harms when there was infrequent reporting of harms in randomized controlled trials. Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy. The history, examination, and interview should include assessment of ASA physical status, age, sex, type of surgery, and potential for difficult airway management as well as consideration of gastroesophageal reflux disease, dysphagia symptoms, other gastrointestinal motility and metabolic disorders (e.g., diabetes mellitus) that may increase the risk of regurgitation and pulmonary aspiration. Effect of metoclopramide on gastric fluid volumes in diabetic patients who have fasted before elective surgery. Do not routinely administer preoperative medications that block gastric acid secretion for the purpose of reducing the risk of pulmonary aspiration in patients with no apparent increased risk for pulmonary aspiration. Differences were not detected in regurgitation43,49,55,66,68,69 (very low strength of evidence) or preoperative vomiting39,5052,62 (low strength of evidence). All other recommendations from the 2017 guideline still apply. First, the Task Force reached consensus on the criteria for evidence. Population: patients undergoing general anesthesia, regional anesthesia, or procedural sedation for elective procedures, Interventions: drinking carbohydrate-containing clear liquids (simple or complex) until 2h before general anesthesia, regional anesthesia, or procedural sedation for elective procedures; drinking protein-containing clear liquids (all studied included carbohydrates) until 2h before general anesthesia, regional anesthesia, or procedural sedation for elective procedures; gum chewing before surgery/procedure; and a shortened duration for clear liquid fasting in children of 1 h, Comparators: fasting or drinking noncaloric clear liquids (e.g., water, placebo, broth, black tea, black coffee); no gum chewing; and clear liquid fasting duration of 2h in pediatric patients. They provide basic recommendations for anesthesia care that are supported by synthesis and analysis of the current literature, expert and practitioner opinion, public comment, and clinical feasibility data. A comparative evaluation of cimetidine and sodium citrate to decrease gastric acidity: effectiveness at the time of induction of anaesthesia. Open forum testimony obtained during development of these guidelines, Internet-based comments, letters, and editorials are all informally evaluated and discussed during the formulation of guideline recommendations. Most patients in the studies were ASA Physical Status I or II with mean or median body mass index of 25kg/m2 (range, 21 to 33kg/m2; see Appendix). A light meal or nonhuman milk may be ingested for up to 6 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.. We further suggest not to delay surgery in healthy adults after confirming removal of chewed gum. Sodium citrate in paediatric outpatients. The methodologists also reviewed the strength of the evidence for each outcome by key question with the task force. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate-rich drink in young children: A randomized crossover study. 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. Guidelines on preoperative fasting from the American Society of Anesthesiologists do not explicitly address gum chewing. Single-dose oral omeprazole for reduction of gastric residual acidity in adults for outpatient surgery. An acceptable significance level was set at P< 0.01 (one-tailed). Rigorous comparisons for equivalence or superiority between 1-h versus 2-h fasting durations in pediatric patients are needed. A randomized controlled trial of preoperative carbohydrate drinks on postoperative walking capacity in elective colorectal surgery. Feb 13, 2014. The addition of protein to preoperative carbohydrate-containing clear liquids did not appear to either benefit or harm healthy patients. Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting. Several pediatric anesthesia practices in the United States now utilize the 1-h fasting duration for clear liquids. Comparative trial of the effect of ranitidine and cimetidine on gastric secretion in fasting patients at induction of anaesthesia. Additional fasting time (e.g., 8 or more hours) may be needed in cases of patient intake of fried foods, fatty foods, or meat. Southern African Journal of Anaesthesia and Analgesia 2020; 26(2)(Supplement 1):S1-75 SVI Foreword to the 2020-2025 edition of the SASA Guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in adults Writing guidelines on procedural sedation and analgesia is a formidable and challenging task. Gastric emptying of three liquid oral preoperative metabolic preconditioning regimens measured by magnetic resonance imaging in healthy adult volunteers: A randomised double-blind, crossover study. Assessment of gastric emptying of maltodextrin, coffee with milk and orange juice during labour at term using point of care ultrasound: A non-inferiority randomised clinical trial. Almost all adult study participants had an ASA Physical Status I or II (92%). asa npo guidelines 2020 chewing tobacco asa npo guidelines 2020 chewing tobacco vo 9 Thng Su, 2022 vo 9 Thng Su, 2022 Case reports and case series, conference abstracts, letters not considered research reports, non-English publications, and animal studies were excluded. Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Girish P. Joshi, Basem B. Abdelmalak, Wade A. Weigel, Monica W. Harbell, Catherine I. Kuo, Sulpicio G. Soriano, Paul A. Stricker, Tommie Tipton, Mark D. Grant, Anne M. Marbella, Madhulika Agarkar, Jaime F. Blanck, Karen B. Domino; 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Preoperative fasting guidelines recommended by the American Society of Anesthesiologists (ASA ) do not allow eating or drinking, for a specific period of time before anesthesia is. Links to the digital files are provided in the HTML text of this article on the Journals Web site (www.anesthesiology.org). The evidence in adults comparing noncaloric clear liquids with those containing protein was limited, with one to two studies reporting each outcome of interest (table 5). A study of smokers92 reported less thirst than those chewing gum (very low strength of evidence). Acid-aspiration prophylaxis by use of preoperative oral administration of cimetidine. Oral preoperative antioxidants in pancreatic surgery: A double-blind, randomized, clinical trial. Supplemental digital content is available for this article. A randomized placebo controlled trial of preoperative carbohydrate drinks and early postoperative nutritional supplement drinks in colorectal surgery. metasens: Statistical methods for sensitivity analysis in meta-analysis. The effect of a new preoperative fasting regime on the subjective perception, postoperative recovery, postoperative complications, and satisfaction in pediatric patients. Is fasting duration important in post adenotonsillectomy feeding time? Conflicts were discussed and, when necessary, included a third methodologist to achieve consensus. Gastric emptying of preoperative carbohydrate in elderly assessed using gastric ultrasonography: A randomized controlled study. Comfort, safety and quality of upper gastrointestinal endoscopy after 2 hours fasting: A randomized controlled trial. The PRISMA flow diagram (https://links.lww.com/ALN/C931) and Literature Search Strategy (https://links.lww.com/ALN/C932) are available as Supplemental Digital Content. Preoperative cimetidineeffects on gastric fluid. Overarching Recommendations for ASCVD Prevention Efforts e601 1. All protein-containing clear liquids also contained carbohydrates. marc scott carpenter obituary. Potential inclusionexclusion discrepancies were also examined with an artificial intelligence tool, a component of the systematic review software. Oral carbohydrate administration in patients undergoing cephalomedullary nailing for proximal femur fractures: An analysis of clinical outcomes and patient satisfaction. Effects of preoperative oral carbohydrates and trace elements on perioperative nutritional status in elective surgery patients. I'd call tobacco somewhere between a "clear" liquid and a light meal and say 4 hours. Tables 4 and 5 summarize the evidence for clinically important outcomes, and supplemental tables 7 to 10 (https://links.lww.com/ALN/C934) detail the strength-of-evidence ratings. Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients. Ingestion of glutamine and maltodextrin two hours preoperatively improves insulin sensitivity after surgery: A randomized, double blind, controlled trial. Table 7 summarizes the evidence for clinically important outcomes. Select options. Girish P. Joshi, M.B.B.S., M.D., Dallas, Texas; Basem B. Abdelmalak, M.D., Cleveland, Ohio; Wade A. Weigel, M.D., Seattle, Washington; Monica W. Harbell, M.D., Phoenix, Arizona; Catherine I. Kuo, M.D., Downers Grove, Illinois; Sulpicio G. Soriano, M.D., Boston, Massachusetts; Paul A. Stricker, M.D., Philadelphia, Pennsylvania; Tommie Tipton, B.S.N., R.N., C.N.O.R., Dallas, Texas; Mark D. Grant, M.D., Ph.D., Schaumburg, Illinois; Anne M. Marbella, M.S., Schaumburg, Illinois; Madhulika Agarkar, M.P.H., Schaumburg, Illinois; Jaime Friel Blanck, M.L.I.S., M.P.A., Baltimore, Maryland; Karen B. Domino, M.D., M.P.H., Seattle, Washington. Benefits, Harms, and Strength of Evidence for Carbohydrate-containing Clear Liquids versus Fasting, Benefits, Harms, and Strength of Evidence for Carbohydrate-containing Clear Liquids versus Noncaloric Clear Liquids. Comments Off on asa npo guidelines 2020 chewing tobacco; June 9, 2022; Clear fluids three hours before surgery do not affect the gastric fluid contents of children. Surgical fasting guidelines in children: Are we putting them into practice? For healthy adults undergoing elective procedures with general anesthesia, regional anesthesia, or procedural sedation, what are the effects of chewing gum on residual gastric volume, gastric pH, and pulmonary aspiration before anesthesia induction? When significant heterogeneity was found among the studies (P< 0.01), DerSimonian-Laird random-effects odds ratios were obtained. Gastric pH and residual volume after 1 and 2h fasting time for clear fluids in children. Conflicts were resolved by consensus. Home. Preoperative fasting guidelines in pediatric anesthesia: Are we ready for a change? Patients drinking carbohydrate-containing clear liquids until 2h before their procedures experienced less hunger and thirst compared to fasting (table 2) and less hunger compared to drinking noncaloric clear liquids (table 3). The guidelines do not address the selection of anesthetic technique, nor do they address enhanced recovery protocols not designed to reduce the perioperative risk of pulmonary aspiration. Oral rehydration therapy for preoperative fluid and electrolyte management. A randomized trial of preoperative oral carbohydrates in abdominal surgery. Antacids may be preoperatively administered to patients at increased risk of pulmonary aspiration. The purpose of this modular update is to evaluate the current evidence on preoperative fasting, focusing on these interventions. Although aspiration is uncommon in healthy ASA Physical Status I or II patients (estimated 1.1/10,000 adults and 1.3/10,000 children),24 it may lead to pneumonitis, pneumonia, and airway obstruction.5,6 Of the aspiration events described in the 2021 ASA Closed Claims analysis of aspiration of gastric contents events, 57% of aspiration incidents resulted in death, and another 15% resulted in permanent severe injury.4 The rationale for preoperative fasting is to minimize gastric content, thereby lowering the risk of regurgitation and subsequent pulmonary aspiration. Level 1: The literature contains a sufficient number of RCTs to conduct meta-analysis, and meta-analytic findings from these aggregated studies are reported as evidence. netmeta: Network meta-analysis using frequentist methods. Both the consultants and ASA members disagree that histamine-2 receptor antagonists should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia in patients with no apparent increased risk for pulmonary aspiration. The strength may be downgraded based on summary study-level risk of bias, inconsistency, indirectness, imprecision, and publication bias. Important consideration should be given to comorbidities that may affect gastric emptying and/or aspiration risk, regardless of ASA Physical Status. Previous ASA guidelines recommend that clear liquids such as water, black coffee, black tea, and juice without pulp are safe to drink until 2 h before general anesthesia, regional anesthesia, or procedural sedation for elective procedures. This article is featured in This Month in Anesthesiology, page A1. ASA members disagree and the consultants strongly disagree that proton pump inhibitors should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia in patients with no apparent increased risk for pulmonary aspiration. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Twelve studies (53%) reported enrolling patients rated with ASA Physical Status I or II (2 studies also included ASA Physical Status III, and 9 did not report ASA Physical Status). Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial. Fifth, the Task Force held an open forum at a major national meeting to solicit input on its draft recommendations. Safety and benefit of pre-operative oral carbohydrate in infants: A multi-center study in China. Aspiration of gastric contents was not evident in the studies. The task force reaffirms the 2017 recommendations for clear liquids until 2h preoperatively.1 Simple or complex carbohydratecontaining clear liquids appear to reduce patient hunger when compared with noncaloric clear liquids. Influence of preoperative fasting time on maternal and neonatal blood glucose level in elective caesarean section under subarachnoid block. Two randomized controlled trials and one large prospective cohort study reported on aspiration and regurgitation.99101 One trial reported no aspiration in either group.99 The other trial included children undergoing surgery for cyanotic congenital heart disease and did not detect a difference in aspiration; however, incidence was high in this population (1.8 and 1.7% in the 1- and 2-h arms respectively).100 A large prospective cohort study that included subgroups of children fasting less than 1h (n = 1,709) and 1 to 2h (n = 2,897) reported higher rates of aspiration and regurgitation in the less than 1-h fasting group (very low strength of evidence) but also noninferiority for regurgitation or pulmonary aspiration (not worse than 1 per 1,000) for a 1- to 2-h clear liquid fast compared with longer times.101. Aspiration,49,53,55,57,80 regurgitation,55,68 and preoperative vomiting85 were not reported in any studies comparing protein-containing clear liquids with noncaloric clear liquids. Throughout these guidelines, the term preoperative should be considered synonymous with preprocedural, as the latter term is often used to describe procedures that are not considered to be operations. A carbohydrate-rich beverage prior to surgery prevents surgery-induced immunodepression: A randomized, controlled, clinical trial. When the relevant data were not reported in the published work, attempts were made to contact the authors. Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial. The effect of pre-operative oral fluids on morbidity following anaesthesia for minor surgery. Metabolic profiles in children during fasting. Chewing gum was allowed either until induction or 30min to 1h before surgery. The administration of preoperative anticholinergics to reduce the risk of pulmonary aspiration is not recommended. The body of evidence included 22 adult surgical studies (20 randomized controlled trials,32,43,49,5255,57,64,68,73,76,80,85,91,148152 1 nonrandomized trial,90 and 1 retrospective cohort165), 7 adult nonsurgical studies (1 randomized controlled trial167 and 6 crossover studies170,171,173176), and 1 pediatric nonsurgical study104 comparing the effects of drinking protein-containing clear liquids with fasting or noncaloric clear liquids. Do preoperative oral carbohydrates improve postoperative outcomes in patients undergoing coronary artery bypass grafts? For each key question, the evidence synthesis and summary tables of benefits and harms were presented to the task force. Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Committee on . Preoperative carbohydrate loading in patients undergoing coronary artery bypass or spinal surgery. These practice guidelines are a modular update of the 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. The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration. A single randomized controlled trial reported higher satisfaction in parents of children with a 1-h clear liquid fast compared with parents of children with a 2-h clear liquid fast99 (very low strength of evidence). The figures were digitized as necessary to obtain quantitative results for synthesis. Bugsnet: An R package to facilitate the conduct and reporting of Bayesian network meta-analyses. Only 2 of the trials randomized participants into 1- and 2-h fasting protocols; the remaining studies were not designed to compare 1- and 2-h fasting; however, they included results from pediatric patients fasted less than 2h. Most children were ASA Physical Status I or II, although one trial enrolling patients with cyanotic congenital heart disease were more likely of higher ASA Physical Status (ASA Physical Status not reported). This is a modular update of the 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. Oral nutrition or water loading before hip replacement surgery: A randomized clinical trial. Evidence was inconsistent for thirst,73,76 and differences in nausea85 were not observed. Comparative trial of the effect of ranitidine and cimetidine on gastric secretion in fasting patients at induction of anaesthesia. For studies that report statistical findings, the threshold for significance is P< 0.01. The 2017 guideline also did not address chewing gum or whether a shorter duration of fasting from clear liquids would be more beneficial than the current recommendation of 2h of fasting for pediatric patients. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Category B: Membership Opinion. Effects of famotidine on gastric pH and residual volume in pediatric surgery. In the U.S., the most popular include chewing tobacco, snuff, snus and dissolvable tobacco . Authors: Amit Rastogi Sanjay Gandhi Post Graduate Institute of Medical Sciences Discover the world's research Content uploaded by. Preparation of these guidelines followed a rigorous methodological process. scented chewing tobacco (tobacco with added flavours) naswar, nas, niswar (tobacco with slaked lime, indigo, cardamom, oil, menthol, water) chillam (heated tobacco) paan (tobacco, areca. Category A evidence represents results obtained from randomized controlled trials (RCTs) and Category B evidence represents observational results obtained from nonrandomized study designs or RCTs without pertinent comparison groups. We suggest not delaying elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation in healthy adults who are chewing gum. A summary of recommendations is found in appendix 1 (table 1). Fourth, opinions about the guideline recommendations were solicited from a random sample of active members of the ASA. Effect of preoperative consumption of high carbohydrate drink (pre-op) on postoperative metabolic stress reaction in patients undergoing radical prostatectomy. Menthol chewing gum on preoperative thirst management: Randomized clinical trial. A complete bibliography used to develop these updated guidelines, arranged alphabetically by author, is available as Supplemental Digital Content 1, http://links.lww.com/ALN/B340. Systematic Review Protocol, https://links.lww.com/ALN/C930, PRISMA flowchart, https://links.lww.com/ALN/C931, Search strategy, https://links.lww.com/ALN/C932, Excluded studies bibliography with reasoning, https://links.lww.com/ALN/C933, Supplemental tables, https://links.lww.com/ALN/C934, Supplemental figures, https://links.lww.com/ALN/C935, Methods Supplement, https://links.lww.com/ALN/C962. Please refer to the table below. Preoperative drinking does not affect gastric contents. Compared with water, residual gastric volume increased in patients chewing gum (very low strength of evidence) in one crossover study.98. Gastric emptying abnormalities in diabetes mellitus. A preliminary study using real-time ultrasound. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Effects of 2-, 4- and 12-hour fasting intervals on preoperative gastric fluid pH and volume, and plasma glucose and lipid homeostasis in children. There is no clinically relevant increase in residual gastric volume after chewing gum92,9497 (low strength of evidence, supplemental fig. The guidelines specifically focus on preoperative fasting recommendations, as well as recommendations regarding the administration of pharmacologic agents to modify the volume and acidity of gastric contents during procedures in which upper airway protective reflexes may be impaired. Plstico Elstico, un programa de msica y canciones de Pacopepe Gil: Power Pop, Punk, Indie Pop, New Wave, Garage To avoid prolonged fasting in children, efforts should be made to allow clear liquids in children at low risk of aspiration as close to 2h before procedures as possible. Healthy adult patients should be encouraged to drink up to 400ml of carbohydrate-containing clear liquids until 2h before an elective procedure to minimize potential harms of prolonged fasting, including hunger and thirst. Home glucometer readings may help guide the patients choice of a carbohydrate or a noncaloric clear liquid. Advise patients at every office visit to avoid exposure to environmental tobacco smoke at home, work, and in public places. Fasting duration is often substantially longer than recommended and prolonged fasting has well described adverse consequences. Welcome! Updated by the American Society of Anesthesiologists Committee on Standards and Practice Parameters: Jeffrey L. Apfelbaum, M.D. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional policies. Gastric residual volume in infants and children following a 3-hour fast. Smoking and gastric juice volume in outpatients. asa npo guidelines 2020 chewing tobaccohershey high school homecoming 2019. Discordant results for residual gastric volume were reported in two trials99,100 randomizing patients to 1- and 2-h fasting. Sugarless gum chewing before surgery does not increase gastric fluid volume or acidity. Tolerance of, and metabolic effects of, preoperative oral carbohydrate administration in childrenA preliminary report. Complications associated with anaesthesiaa prospective survey in France. Ninety-six percent of the respondents indicated that the guidelines would have no effect on the amount of time spent on a typical case. The effect of metoclopramide on gastric contents after preoperative ingestion of sodium citrate. Effects of preoperative oral carbohydrate supplementation on postoperative metabolic stress response of patients undergoing elective abdominal surgery. Patient positioning such that a magnet cannot be used (prone, lateral, severe obesity, etc.). Aspiration was not reported in any of the included studies (randomized controlled trials32,43,49,5255,64 or nonrandomized designs90). Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Clear liquids may be ingested for up to 2 h before procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia. 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 Effect of preoperative feeding on gastric emptying following spinal anesthesia: A randomized controlled trial. Verify patient compliance with fasting requirements at the time of their procedure. Healthcare database searches included PubMed, Web of Science, Google Books, and the Cochrane Central Register of Controlled Trials. poems about making mistakes and learning from them Plstico Elstico. These liquids should not include alcohol. Effects of a carbohydrate-, glutamine-, and antioxidant-enriched oral nutrition supplement on major surgery-induced insulin resistance: A randomized pilot study. Anesthesiology 2011; 114:495511. Anesthesiology 2013; 118:291307. Small study effects and the potential for publication bias were evaluated using funnel plots and regression-based tests.12 Analyses were conducted in R (R Foundation for Statistical Computing, Vienna, Austria).1315 (See the methods supplement for further details, https://links.lww.com/ALN/C962.). This guide was updated in . The anesthesiologist and patient representative task force members rated the importance of each outcome for decision-making on a scale of 1 to 9 (1 to 3, of limited importance; 4 to 6, important; 7 to 9, critical).8 The evidence synthesis focused on the outcomes rated important or critical. Effect of gum chewing on gastric volume and emptying: A prospective randomized crossover study. Effect of the preoperative administration of water on gastric volume and pH. The effect of preoperative oral intake of liquid carbohydrate on postoperative stress parameters in patients undergoing laparoscopic cholecystectomy: An experimental study. Two combined probability tests were employed as follows: (1) the Fisher combined test, producing chi-square values based on logarithmic transformations of the reported P values from the independent studies, and (2) the Stouffer combined test, providing weighted representation of the studies by weighting each of the standard normal deviates by the size of the sample. Pulmonary aspiration of gastric contents: A closed claims analysis. Due to the rarity of aspiration, regurgitation, gastric volume, and gastric pH were included as intermediate outcomes. When an equal number of categorically distinct responses are obtained, the median value is determined by calculating the arithmetic mean of the two middle values. Single-dose intravenous H2 blocker prophylaxis against aspiration pneumonitis: assessment of drug concentration in gastric aspirate. Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy. Effect of preoperative oral carbohydrate administration on patients undergoing cesarean section with epidural anesthesia: A pilot study. How to perform a meta-analysis with R: A practical tutorial. Differences were not detected in patient-rated or rates of hunger,32,43 thirst,32,43 or preoperative nausea32,43 (all very low strength of evidence).
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