RoshQuiz Answer 1.1

You are planning to perform procedural sedation to reduce a fracture. The patient’s last meal was 4 hours ago. How much additional time should you wait to perform the procedure?

A. 2 hrs

B. 4 hrs

C. 6 hrs

D. No waiting is necessary

ANSWER: According to Godwin et al., do not delay procedural sedation in adults or pediatric patients in the ED based on fasting time. No reduction in risk of emesis or aspiration has been shown with any fasting duration. This is a Level B recommendation. Outside of emergency medicine, other professional society guidelines recommend a 2-hour fasting time for clear liquids, 4-hour fasting for breast milk, and 6-hour fasting for solids. These guidelines are based on an extrapolation of data from general anesthesia cases, in which intubation and extubation airway manipulation may increase aspiration risk. Several Class II trials demonstrated no significant difference in rates of emesis or aspiration when comparing various fasting times, and no serious adverse events caused by emesis or aspiration were found.

According to Godwin et al., it is not required to delay procedural sedation for 2 (A), 4 (B), or 6 (C) hours to allow a longer fasting time.

Godwin SA, Burton JH, American College of Emergency Physicians, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014;63(2):247-258.

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