Think drink! Current fasting guidelines are outdated

<span class="paragraphSection">Ever since the formative work of Curtis Mendelson<a href="#aew450-B1" class="reflinks">¹</a> in peripartum women, the need for preoperative fasting has been propagated to help to minimize the risk of pulmonary aspiration of gastric content during anaesthesia. That early work described the catastrophic consequences of particulate matter aspiration but also reported all those who aspirated non-particulate matter (40 patients out of 44 016) survived. This is notable considering the lack of sophisticated postoperative monitoring and care more than seven decades ago. Fasting guidelines and recommendations have been produced as a consequence of this early work, with the majority advocating a 6 h fast for solids, 4 h for breast milk, and 2 h for clear fluids for elective surgery in both adults and children,<a href="#aew450-B2" class="reflinks">²</a> <a href="#aew450-B3" class="reflinks">³</a> the so-called 6–4–2 rule. Uncertainty remains for trauma patients, whereas obstetric patients are considered to have a full stomach.</span>

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