The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperativelyA randomised clinical trial. Nine (9%) trials included diabetic patients (from 2 to 100% of participants). Updated by the American Society of Anesthesiologists Task Force on Preoperative Fasting. 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. The purposes of these guidelines are to provide direction for clinical practice related to preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration and to reduce the severity of complications related to perioperative pulmonary aspiration. Category C: Informal Opinion. Observational studies indicate that some predisposing patient conditions (e.g., age, sex, ASA physical status, emergency surgery) may be associated with the risk of perioperative aspiration (Category B2-H evidence).15 Observational studies addressing other predisposing conditions (e.g., obesity, diabetes, esophageal reflux, smoking history) report inconsistent findings regarding risk of aspiration (Category B1-E evidence).611. The evidence comparing fasting with protein-containing clear liquids in adults was limited to single trials for each patient-reported outcome (table 4). Chewing gum was allowed either until induction or 30min to 1h before surgery. The 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. Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients. Large volumes of apple juice preoperatively do not affect gastric pH and volume in children. Pre-operative oral carbohydrate loading in colorectal surgery: A randomized controlled trial. Gastric emptying of preoperative carbohydrate in elderly assessed using gastric ultrasonography: A randomized controlled study. Dip tobacco, also known as smokeless tobacco, snuff, or chewing tobacco, is a type of tobacco that is consumed by placing a portion of the tobacco between the cheek and gum or teeth and chewing. Conflicts were discussed and, when necessary, included a third methodologist to achieve consensus. Responses to atropine, glycopyrrolate, and riopan of gastric fluid pH and volume in adult patients. Prophylactic single-dose oral antacid therapy in the preoperative periodcomparison of cimetidine and Maalox. Comprehensive bibliographic database searches were conducted by a medical librarian using PubMed, EMBASE, and SCOPUS in July 2020 and updated in December 2021. 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. 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). Safe pre-operative fasting times after milk or clear fluid in children. 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, A Tool to Screen Patients for Obstructive Sleep Apnea, ACE (Anesthesiology Continuing Education), https://doi.org/10.1097/ALN.0000000000001452, 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, 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, Psychiatric Disorders and Psychopharmacologic Treatment as Risk Factors in Elective Fast-track Total Hip and Knee Arthroplasty, Anomalous Drainage of Inferior Vena Cava into the Left Atrium, Ultrasound-guided Visualization of Subglottic Secretions in Intubated Patients, Lung Pulse with Pneumothorax: Examine the Thoracic Artery and Veins, Copyright 2023 American Society of Anesthesiologists. Complications of aspiration include, but are not limited to, aspiration pneumonia, respiratory compromise, and related morbidities. Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Investigation of preoperative fasting times in children. These liquids should not include alcohol. Gastric fluid pH in patients receiving sodium citrate. Medications that block gastric acid secretion may be preoperatively administered to patients at increased risk of pulmonary aspiration. asa npo guidelines 2020 chewing tobacco asa npo guidelines 2020 chewing tobacco vo 9 Thng Su, 2022 vo 9 Thng Su, 2022 Cimetidine in the prevention of acid aspiration during anesthesia. All protein-containing clear liquids in the trials included carbohydrates, precluding assessment of liquids containing only protein. Reduction of complications associated with pulmonary aspiration. Both the consultants and ASA members agree that for infants, fasting from the intake of nonhuman milk for 6 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. chewing tobacco npo guidelines. Accepted for publication October 26, 2016. Tobacco Use and Cessation. In 2015, the ASA Committee on Standards and Practice Parameters requested that the updated guidelines published in 2011 be re-evaluated. Gastric residual volume in infants and children following a 3-hour fast. Sodium citrate in paediatric outpatients. Going from evidence to recommendationDeterminants of a recommendations direction and strength. The body of evidence was first described according to study characteristics and treatment arms. Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial.
asa npo guidelines 2020 chewing tobacco - plasticoelastico.es The effect of a small drink. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. should I observe the same fasting intervals? These guidelines are intended for use by anesthesiologists and other anesthesia providers. Level 2: The literature contains multiple RCTs, but the number of RCTs is not sufficient to conduct a viable meta-analysis for the purpose of these updated guidelines. Preoperative fasting abbreviation and its effects on postoperative nausea and vomiting incidence in gynecological surgery patients. Actively encouraging clear liquids in healthy children as close to 2h before procedures as possible is important to avoid them. Total hip arthroplasty and perioperative oral carbohydrate treatment: A randomised, double-blind, controlled trial. The body of evidence included 139 studies (adult surgical: 99 randomized controlled trials,2334,3664,6886,91,118157 7 nonrandomized trials,65,66,87,152,158160 3 prospective cohort studies,90,161,162 2 retrospective cohort studies,163,164 1 case-control study,165 and 2 beforeafter studies67,166; adult nonsurgical: 1 randomized controlled trial,167 9 crossover,168176 and 2 nonrandomized trials177,178; pediatric surgical: 9 randomized controlled trials,100,113,179185 1 prospective cohort186; and pediatric nonsurgical: 2 randomized controlled trial,102,104 1 crossover,35 and 1 prospective cohort103) comparing carbohydrate-containing clear liquids (simple, complex) with water, placebo, or fasting. A new histamine H2-receptor antagonist. None of the studies received industry support, and 1 study noted author conflict of interest. For adults undergoing elective procedures with general anesthesia, regional anesthesia, or procedural sedation, what are the benefits and harms of protein-containing clear liquids 2h before the procedure compared with fasting and other clear liquids?
Fasting guidelines of international anesthesia societies Aspiration can occur during any type of anesthesia, as a result of . netmeta: Network meta-analysis using frequentist methods. Effects of preoperative oral carbohydrates and trace elements on perioperative nutritional status in elective surgery patients. Copyright 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. Preoperative drinking does not affect gastric contents. 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.
Sedation Administration - SGNA They also strongly agree that patients should be informed of fasting requirements and the reasons for them sufficiently in advance of their procedures. 5. Please refer to the table below. We suggest not delaying elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation in healthy adults who are chewing gum. 6.
chewing tobacco | Student Doctor Network Patients chewing gum had a minimally increased residual gastric volume at anesthesia induction compared with fasting (table 6). Ranitidine and prevention of pulmonary aspiration syndrome. Both the consultants and ASA members agree that for neonates and infants, fasting from the intake of infant formula for 6 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. For patients undergoing elective procedures, this update addresses: Carbohydrate-containing clear liquids (simple or complex), Clear liquid fasting duration (1h vs. 2h) for children. Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care. A comparison of lansoprazole, omeprazole, and ranitidine for reducing preoperative gastric secretion in adult patients undergoing elective surgery. Black or white coffee before anaesthesia? Effects of a carbohydrate loading on gastric emptying and fasting discomfort: An ultrasonography study. The incidence and outcome of perioperative pulmonary aspiration in a university hospital: A 4-year retrospective analysis. Fasting duration is often substantially longer than recommended and prolonged fasting has well described adverse consequences. Determinants of liquid gastric emptying: comparisons between milk and isocalorically adjusted clear fluids. Volume and pH of gastric juice in obese patients. Prevention of perioperative pulmonary aspiration is part of the process of preoperative evaluation and preparation of the patient. 21, https://links.lww.com/ALN/C935, and supplemental table 15, https://links.lww.com/ALN/C934). The consultants agree and the ASA members strongly agree that fasting from the intake of a light meal ( e.g ., toast and a clear liquid) of 6 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. Due to the rarity of aspiration, regurgitation, gastric volume, and gastric pH were included as intermediate outcomes. 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. Effect of preoperative consumption of high carbohydrate drink (pre-op) on postoperative metabolic stress reaction in patients undergoing radical prostatectomy. 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. michael emerson first wife; bike steering feels heavy; asa npo guidelines 2020 chewing tobacco Observational (e.g., correlational or descriptive statistics). For the safety of our patients, Columbia Anesthesia Group has adopted the ASA guidelines for NPO (nothing by mouth) status in perioperative patients. In summary, the evidence showed that for patients with low risk of aspiration, carbohydrate-containing clear liquids until 2h preoperatively was superior to absolute fasting with respect to beneficial outcomes, without evidence of increased risks. Feb 13, 2014. poems about making mistakes and learning from them Plstico Elstico.
NPO Guidelines | Anesthesiology: A Problem-Based - Oxford Academic Outcomes assessed were limited to gastric volume, gastric acidity, nausea, and vomiting (table 2). Use of ultrasound for gastric volume evaluation after ingestion of different volumes of isotonic solution. Preoperative fasting in children: An audit and its implications in a tertiary care hospital. Additional fasting time (e.g., 8 or more hours) may be needed in cases of patient intake of fried foods, fatty foods, or meat. Anesthesiology 2011 ; 114: 495-511. Although the relationship between gastric volume and gastric emptying time with aspiration risk has not been demonstrated in adequately powered studies,7 most published studies have used these measures as intermediate outcomes. Does preoperative oral carbohydrate treatment reduce the postoperative surgical stress response in lumbar disc surgery? The consultants agree and the ASA members strongly agree that fasting from the intake of a light meal (e.g., toast and a clear liquid) of 6 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. Third, expert consultants were asked to: (1) participate in opinion surveys on the effectiveness of various preoperative fasting strategies and pharmacologic agents and (2) review and comment on a draft of the guidelines developed by the Task Force. Are you thirsty?Fasting times in elective outpatient pediatric patients. Ultrasound assessment of gastric emptying time after intake of clear fluids in children scheduled for general anesthesia: A prospective observational study. 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. Lansoprazole reduces preoperative gastric fluid acidity and volume in children. Metabolic profiles in children during fasting. Evaluation of the effects of a preoperative 2-hour fast with maltodextrine and glutamine on insulin resistance, acute-phase response, nitrogen balance, and serum glutathione after laparoscopic cholecystectomy: A controlled randomized trial. Participants drinking carbohydrate-containing clear liquids had lower patient-rated hunger (supplemental figs. The effect of preoperative oral carbohydrate administration on insulin resistance and comfort level in patients undergoing surgery. Tolerance of, and metabolic effects of, preoperative oral carbohydrate administration in childrena preliminary report. asa npo guidelines 2020 chewing tobacco . Proton pump inhibitors: Meta-analysis of placebo-controlled RCTs indicate that omeprazole is effective in reducing gastric volume and acidity (Category A1-B evidence).63,67,9395 RCTs report similar findings for lansoprazole (Category A2-B evidence),67,68,96,97 pantoprazole (Category A2-B evidence),63,73,98 and rabeprazole (Category A3-B evidence).68 The literature is insufficient to evaluate the effect of administering proton pump inhibitors on perioperative pulmonary aspiration or emesis/reflux. Potential inclusionexclusion discrepancies were also examined with an artificial intelligence tool, a component of the systematic review software. Ultrasound assessment of gastric volume in children after drinking carbohydrate-containing fluids. The evidence suggests there is not a clinically meaningful increase in gastric volume after chewing gum. Single-dose intravenous H2 blocker prophylaxis against aspiration pneumonitis: assessment of drug concentration in gastric aspirate. Evidentiary information and recommendations regarding the administration of preoperative gastrointestinal stimulants and postoperative nausea and vomiting findings may be found in: Practice guidelines for postanesthetic care: An updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesia care during procedures refers to general anesthesia, regional anesthesia, or procedural sedation and analgesia. anyone else have different thoughts? The consultants agree and the ASA members strongly agree that for otherwise healthy neonates (< 44 gestational weeks) and infants, fasting from the intake of breast milk for 4 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. 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. Patient positioning such that a magnet cannot be used (prone, lateral, severe obesity, etc.). All other recommendations from the 2017 guideline still apply. For these guidelines, the primary outcomes of interest are pulmonary aspiration and the frequency or severity of adverse consequences associated with aspiration (e.g., pneumonitis). A randomized trial of preoperative oral carbohydrates in abdominal surgery. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. 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. chewing tobacco npo guidelines. 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). Preanesthetic cimetidine and metoclopramide for acid aspiration prophylaxis in elective surgery. The risk of bias for individual studies was evaluated using tools according to study design: for randomized controlled trials, the Cochrane risk of bias tool,16 and for nonrandomized studies, the Risk Of Bias In Non-Randomised Studies of Interventions tool.17 The risk of bias appraisals for only randomized controlled trials were used to support all strength-of-evidence ratings (supplemental figs. Practice guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. Impact of oral carbohydrate consumption prior to cesarean delivery on preoperative well-being: A randomized interventional study. When significant heterogeneity was found among the studies (P< 0.01), DerSimonian-Laird random-effects odds ratios were obtained. Studies examining carbohydrate- and protein-containing clear liquids published in January 2000 or later were eligible for inclusion. The effect of shortening the pre-operative fluid fast on postoperative morbidity. Paediatric glucose homeostasis during anaesthesia. Moreover, there is a need to study gastric emptying and gastric pH in critically ill patients receiving enteral feeding to determine the shortest safe duration of fasting before surgery in that population to minimize feeding interruptions. Parents understanding of and compliance with fasting instruction for pediatric day case surgery. Submitted for publication May 18, 2022. The consultants and ASA members both strongly agree that, when antacids are indicated for selected patients, only nonparticulate antacids should be used. When tobacco is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain; if the smoke is not directly inhaled into the lungs, nicotine is absorbed . 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. Key Points. Influence of cigarette smoking on the risk of acid pulmonary aspiration. Approved by the ASA House of Delegates on October 26, 2016. Fv 27, 2023 . Comfort, safety and quality of upper gastrointestinal endoscopy after 2 hours fasting: A randomized controlled trial. A difference was not detected in gastric pH between the groups. Survey responses from expert and membership sources are recorded using a 5-point scale and summarized based on median values. Regurgitation49,55,77 or preoperative vomiting39,75,82,85 did not differ in randomized controlled trials (very low strength of evidence). 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. Effects of fasting and oral premedication on the pH and volume of gastric aspirate in children. Meta-analysis of placebo-controlled RCTs indicate that metoclopramide is effective in reducing gastric volume and pH during the perioperative period (Category A1-B evidence).5560 The literature is insufficient to evaluate the effect of metoclopramide on the perioperative incidence of pulmonary aspiration.***. asa npo guidelines 2020 chewing tobacco Call us today! Eligible studies included randomized and nonrandomized trials, quasiexperimental, cohort (prospective and retrospective), and case-control designs. Evidence was inconsistent for thirst,73,76 and differences in nausea85 were not observed. Ask patients about tobacco use at every office visit. Aspiration was not reported in any of the included studies (randomized controlled trials32,43,49,5255,64 or nonrandomized designs90). Gastric volume and pH in infants fed clear liquids and breast milk prior to surgery. Preoperative nutrition and postoperative discomfort in an eras setting: A randomized study in gastric bypass surgery. 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. If you don't need to print the chewing tobacco and npo guidelines surgery, you can print the specific page you need. A preliminary study using real-time ultrasound. The effects of chewing gum on gastric content prior to induction of general anesthesia. When warranted, the Task Force may add educational information or cautionary notes based on this information. Placebo-controlled RCTs are equivocal regarding the efficacy of glycopyrrolate to reduce gastric volume or acidity (Category A2-E evidence),83,102 and two nonrandomized placebo-controlled comparative studies report equivocal findings the efficacy of atropine on gastric volume and acidity (Category B1-E evidence).103,104. (Chair). There is insufficient evidence to recommend protein-containing clear liquids preferentially over other clear liquids 2h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation (no recommendation). Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. The impact and safety of preoperative oral or intravenous carbohydrate administration. asa npo guidelines 2020 chewing tobacconewtonian telescope 275mm f/5,3. Almost all adult study participants had an ASA Physical Status I or II (92%). This document updates the Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: An Updated Report adopted by the ASA in 2010 and published in 2011.. Supplemental tables 1 to 4 (https://links.lww.com/ALN/C934) detail the strength-of-evidence ratings. In this respect, the Sub-Group has produced CORESTA Guide No. Preoperative fasting guidelines in pediatric anesthesia: Are we ready for a change? Comparative ultrasound study of gastric emptying between an isotonic solution and a nutritional supplement. Table 6 summarizes the evidence for clinically important outcomes. 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.
asa npo guidelines 2020 chewing tobacco - jvillejanitorial.com Effect of oral liquids and ranitidine on gastric fluid volume and pH in children undergoing outpatient surgery. tamko building products ownership; 30 Junio, 2022; asa npo guidelines 2020 chewing tobacco . Effect of a single intravenous dose on pH and volume of gastric aspirate. An odds ratio procedure based on the Mantel-Haenszel method for combining study results using 2 x 2 tables was used with outcome frequency data. Benefits, Harms, and Strength of Evidence for Chewing Gum versus Fasting. However, if a patient chews gum for personal comfort or preference, we recommend not delaying the scheduled elective procedure, due to inconclusive evidence of harm.
CAG - Fasting Guidelines South African Society of Anaesthesiologists (Sasa) Procedures whereby upper airway protective reflexes are not impaired, Procedures whereby no risk factors for pulmonary aspiration are apparent. One study included younger children (mean age, 3 yr), 2 included children with mean or median age of 5 yr, and the remaining studies reported median ages ranging from 7 to 11 yr. Five studies were conducted in surgical settings, and 4 were nonsurgical. Oral carbohydrate administration in patients undergoing cephalomedullary nailing for proximal femur fractures: An analysis of clinical outcomes and patient satisfaction. Aspiration of gastric contents was not evident in the studies. Clinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft surgery. 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. 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. The impact of oral carbohydrate-rich supplement taken two hours before caesarean delivery on maternal and neonatal perioperative outcomesA randomized clinical trial. R: A language and environment for statistical computing. Meta-analyses from other sources are reviewed but not included as evidence in this document. For the previous update, 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 ASA membership, (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. Make it a reward and less of a an addiction. These seven evidence linkages are: (1) preoperative fasting of liquids between 2 and 4 h for adults, (2) preoperative fasting of liquids between 2 and 4 h for children, (3) preoperative metoclopramide, (4) preoperative ranitidine (orally administered), (5) preoperative cimetidine (orally administered), (6) preoperative omeprazole (orally administered), and (7) perioperative ondansetron (intravenously administered).