Fasting Guidelines. 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. A difference was not detected in gastric pH92,9497 (low strength of evidence, supplemental table 16, https://links.lww.com/ALN/C934). 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 . Part I: Coffee or orange juice. Aspiration was not reported in any of the included studies (randomized controlled trials32,43,49,5255,64 or nonrandomized designs90). Decreased risk of dehydration or hypoglycemia from prolonged fasting. It is illegal to commercially import or sell smokeless tobacco products in Australia - this includes oral snuff, tobacco paste and powder and chewing tobacco. Copyright 2023 American Society of Anesthesiologists. Supplemental tables 13 and 14 (https://links.lww.com/ALN/C934) detail the strength-of-evidence ratings. Effect of oral glucose water administration 1 hour preoperatively in children with cyanotic congenital heart disease: A randomized controlled trial. Editorials, letters, and other articles without data were excluded. Both the systematic literature review and opinion data are based on evidence linkages, or statements regarding potential relationships between preoperative fasting interventions and pulmonary aspiration or associated complications. Please refer to the table below. Rectal and oral cimetidine for prophylaxis of aspiration pneumonitis in paediatric anaesthesia. Level 3: The literature contains noncomparative observational studies with descriptive statistics (e.g., frequencies, percentages). How to perform a meta-analysis with R: A practical tutorial. There was inconclusive evidence concerning residual gastric volume in nonsurgical studies that included comparisons of protein-containing clear liquids compared with carbohydrate-containing clear liquids alone (supplemental tables 11 and 12, https://links.lww.com/ALN/C934). Clinical significance of pulmonary aspiration during the perioperative period. Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: A prospective randomized controlled trial. Antiemetics may be preoperatively administered to patients at increased risk of postoperative nausea and vomiting. An acceptable significance level was set at P< 0.01 (one-tailed). Safety and efficacy of oral rehydration therapy until 2h before surgery: A multicenter randomized controlled trial. Prophylactic single-dose oral antacid therapy in the preoperative periodcomparison of cimetidine and Maalox. These guidelines do not address the use of antiemetics during the extended postoperative period after upper airway protective reflexes are no longer impaired. Aspiration pneumonitis and aspiration pneumonia. Ranitidine and metoclopramide for prophylaxis of aspiration pneumonitis in elective surgery. Advise tobacco users to quit. Benefits of fasting abbreviation with carbohydrates and omega-3 infusion during CABG: A double-blind controlled randomized trial. Mixed treatment comparisons did not support the superiority of complex carbohydrates over simple carbohydrates with respect to residual gastric volume or hunger (network meta-analysis; supplemental figs. : A randomised crossover trial. Authors: Amit Rastogi Sanjay Gandhi Post Graduate Institute of Medical Sciences Discover the world's research Content uploaded by. Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy. Tobacco's calories (if there's any) is insignificant to interrupt weight loss. GRADE guidelines: 2. Perioperative pulmonary aspiration is defined as aspiration of gastric contents occurring after induction of anesthesia, during a procedure, or in the immediate postoperative period. Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: A randomized, controlled trial. 5. Oral ranitidine for prophylaxis against Mendelsons syndrome. Hypoglycaemia in children before operation: its incidence and prevention. Reduction of complications associated with pulmonary aspiration. Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol. For each key question, the evidence synthesis and summary tables of benefits and harms were presented to the task force. The methodologists also reviewed the strength of the evidence for each outcome by key question with the task force. 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. Perform a review of pertinent medical records, a physical examination, and patient survey or interview as part of the preoperative evaluation. Effect of preoperative oral carbohydrate administration on patients undergoing cesarean section with epidural anesthesia: A pilot study. The original guidelines and the previous update in 2011 was developed by means of a seven-step process. Fasting and Pharmacologic Recommendations. Sodium citrate in paediatric outpatients. Effect of preoperative feeding on gastric emptying following spinal anesthesia: A randomized controlled trial. A summary of recommendations is found in appendix 1 (table 1). Effect of preoperative intravenous carbohydrate loading on preoperative discomfort in elective surgery patients. Drinking carbohydrate-containing clear liquids resulted in lower hunger ratings than did noncaloric clear liquids (moderate strength of evidence).23,24,26,39,41,7275 Differences were not evident for patient ratings of thirst23,24,26,39,41,72,73,7577 (low strength of evidence) and nausea23,24,26,73 (low strength of evidence) or in rates of preoperative thirst78 and nausea23,24,26,39,73,79 (both very low strength of evidence). 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. Supplemental tables 17 through 19 (https://links.lww.com/ALN/C934) detail the strength-of-evidence ratings. Post author: Post published: 24, 2023; Post category: is shane harper related to adam sandler; Post comments: . For these guidelines, preoperative fasting is defined as a prescribed period of time before a procedure when patients are not allowed the oral intake of liquids or solids. Effects of oral carbohydrate with amino acid solution on the metabolic status of patients in the preoperative period: A randomized, prospective clinical trial. All opinion-based evidence (e.g., survey data, open forum testimony, internet-based comments, letters, and editorials) relevant to each topic was considered in the development of these updated guidelines. Aspiration of gastric contents is associated with increased perioperative morbidity and mortality [ 1-3 ], with highest risk associated with high volume, acidic, or particulate aspiration. Attenuation of gastric effects of famotidine by preoperative administration of intravenous fluids. Due to the rarity of aspiration, regurgitation, gastric volume, and gastric pH were included as intermediate outcomes. Impact of oral carbohydrate consumption prior to cesarean delivery on preoperative well-being: A randomized interventional study. Ninety-six percent of the respondents indicated that the guidelines would have no effect on the amount of time spent on a typical case. 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. Effect of pre-operative oral carbohydrate loading on recovery after day-case cholecystectomy: A randomised controlled trial. 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. Comparisons and questions of interest include, Carbohydrate-containing clear liquids (simple and complex) compared with fasting and noncaloric clear liquids, Simple carbohydratecontaining clear liquids compared with complex carbohydratecontaining clear liquids, Carbohydrate-containing clear liquids (simple and complex) compared with clear protein-containing liquids alone, Protein-containing clear liquids alone compared with fasting and other clear liquids, Adding milk or cream to coffee or tea versus fasting and other clear liquids, The impact of carbohydrate-containing clear liquids on glycemic levels in patients with diabetes, There is a need for studies evaluating gastric volume, gastric emptying, and aspiration in patients with high risk of regurgitation. Prolonged fasting has well described adverse consequences. The guidelines may not apply to or may need to be modified for patients with coexisting diseases or conditions that can affect gastric emptying or fluid volume (e.g., pregnancy, obesity, diabetes, hiatal hernia, gastroesophageal reflux disease, ileus or bowel obstruction, emergency care, or enteral tube feeding) and patients in whom airway management might be difficult. Effects of a preoperative carbohydrate-rich drink before ambulatory surgery: A randomized controlled, double-blinded study. 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. Pre-operative oral carbohydrate loading in colorectal surgery: A randomized controlled trial. 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. Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy. However, studies in children are limited, lack significant power to detect uncommon risks, and clinical controversy exists.117, There is a need for well designed, adequately powered randomized trials or large prospective cohort studies in both adults and children to evaluate uncommon adverse events and patient-reported outcomes including preoperative thirst, hunger, anxiety, and patient satisfaction. Inconsistent results were reported for residual gastric volume. Reducing pre-operative fasting while preserving operating room scheduling flexibility: Feasibility and impact on patient discomfort. Participants drinking carbohydrate-containing clear liquids had lower patient-rated hunger (supplemental figs. Effects of preoperative oral carbohydrates and trace elements on perioperative nutritional status in elective surgery patients. The effect of pre-operative intake of oral water and ranitidine on gastric fluid volume and pH in children undergoing elective surgery. (Chair), Chicago, Illinois; Madhulika Agarkar, M.P.H., Schaumburg, Illinois; Richard T. Connis, Ph.D., Woodinville, Washington; Charles J. Cot, M.D., Boston, Massachusetts; David G. Nickinovich, Ph.D., Bellevue, Washington; and Mark A. Warner, M.D., Rochester, Minnesota. Fasting duration is often substantially longer than recommended irrespective of a 1- or 2-h clear liquid fasting policy.107112 Prolonged fasting influences patient-related outcomes (preoperative thirst, hunger, anxiety, nausea and vomiting, pain, and reduced feeling of well-being) and clinical outcomes (dehydration, electrolyte imbalance, and hypotension at induction of general anesthesia).113,114 Due to low-quality evidence, the task force was unable to make a recommendation for reducing the clear liquid fasting duration to 1h in the pediatric population. Findings from the aggregated literature are reported in the text of the guidelines by evidence category, level, and direction and in appendix 2 (table 2). Occurrence of gastroesophageal reflux on induction of anaesthesia does not correlate with the volume of gastric contents. Furthermore, it would be necessary to update related policies, printed literature, and wall posters/charts to ensure that patients are receiving consistent messages and instructions from all medical personnel. 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. Patient satisfaction31,46 was reported in only two trials, and a difference could not be assessed (low strength of evidence). 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. Menthol flavored smokeless tobacco products comprised more than half of all sales revenues (54.5 percent); tobacco flavored products (that is, no added flavor) comprised 43.4 percent; and fruit flavored smokeless tobacco products . Evaluating ranitidine, pantoprazole and placebo on gastric pH in elective surgery. Effect of a single intravenous dose on pH and volume of gastric aspirate. Association of nausea and length of stay with carbohydrate loading prior to total joint arthroplasty. Scientific evidence used in the development of these updated guidelines is based on cumulative findings from literature published in peer-reviewed journals. 17, https://links.lww.com/ALN/C935) or gastric pH46,50,51,69,71 after fasting or drinking carbohydrate-containing clear liquids (moderate strength of evidence). Single trials reported less hunger73 and greater satisfaction80 among patients drinking protein-containing clear liquids compared with patients drinking other clear liquids (very low strength of evidence). Outcomes: adverse effects of fasting (preoperative hunger, thirst, and nausea) and pulmonary aspiration. Effects of fasting and oral premedication on the pH and volume of gastric aspirate in children. Aspiration can occur during any type of anesthesia, as a result of . The characteristics of randomized trials supporting recommendations for adult surgical patients included a median of 46 participants (range, 20 to 150). Patient satisfaction46,80 was reported in two trials, with higher satisfaction in patients drinking carbohydrate-containing clear liquids (low strength of evidence). Paediatric glucose homeostasis during anaesthesia. Trials provided participants with a median of 400ml (interquartile range, 300 to 400ml) of clear liquids 2h before anesthesia administration without adverse consequences. 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. 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 Com. Preoperative Fasting - The National Institute for Health and Care . Does preoperative oral carbohydrate reduce hospital stay? Medications that block gastric acid secretion may be preoperatively administered to patients at increased risk of pulmonary aspiration. Evaluation of effects of a preoperative 2-hour fast with glutamine and carbohydrate rich drink on insulin resistance in maxillofacial surgery. Outcomes assessed were limited to gastric volume, gastric acidity, nausea, and vomiting (table 2). Omeprazole reduces preoperative gastric fluid acidity and volume in children. The complex carbohydrate used in the carbohydrate-loading interventions was maltodextrin. For adults undergoing elective procedures with general anesthesia, regional anesthesia, or procedural sedation, what are the benefits and harms of carbohydrate-containing clear liquids ingested until 2h before the procedure compared with fasting and noncaloric clear liquids? Supplemental digital content is available for this article. Anesthesiology 2013; 118:291307. A study of smokers92 reported less thirst than those chewing gum (very low strength of evidence). Comparison of different non-pharmacological preoperative preparations on gastric fluid volume and acidity: A randomized controlled trial. Chewing gum in the preoperative fasting period: An analysis of de-identified incidents reported to webairs. Fourth, opinions about the guideline recommendations were solicited from a random sample of active members of the ASA. Although the task force does not recommend delaying surgery in healthy adults who have chewed gum during the fasting period, we urge clinicians to confirm the gum has been removed before anesthetic administration. You will also find usable tools to guide your practice and help you integrate tobacco treatment into routine clinical care. 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. Trial participants ingested a median of 400ml of carbohydrate-containing clear liquids (interquartile range, 300 to 400ml) up to 2h before anesthesia administration. 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). Preoperative fastingnihil per os a difficult myth to break down: A randomized controlled study. Preoperative oral carbohydrate loading in laparoscopic gynecologic surgery: A randomized controlled trial. Gastric fluid volume and pH in elective inpatients. Ingestion of clear fluids is safe for adolescents up to 3h before anaesthesia. These guidelines are intended for use by anesthesiologists and other anesthesia providers. 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. Recent European115 and Canadian116 guidelines have recommended reducing clear liquid fasting to 1h in children. Do not routinely administer preoperative gastrointestinal stimulants for the purpose of reducing the risk of pulmonary aspiration in patients with no apparent increased risk for pulmonary aspiration. These liquids should not include alcohol. In children with shorter clear liquid fasting duration, exercise clinical judgment. Up to 400ml of clear liquids is considered an appropriate volume. Sixth, the consultants were surveyed to assess their opinions on the feasibility of implementing the updated guidelines. Dr. Joshi is a consultant for Baxter Healthcare (Deerfield Illinois) and Pacira Pharmaceuticals (Parsippany New Jersey), Dr. Abdelmalak is a consultant and speaker for Acacia Pharma (Duxford United Kingdom) and Medtronic USA Inc. (Minneapolis Minnesota), and Dr. Domino has received a research grant from Edwards Life Science Corporation (Irvine California). The American Society of Anesthesiologists (ASA) recommends patients to fast from fatty food or meats eight (8) hours prior to surgery, non-human milk or light meal for six (6) hours prior, breast milk for four (4) hours prior, and clear liquids including water, pulp-free juice, and tea or coffee without milk for two (2) hours prior to the excel the chart data range is too complex. The strength may be downgraded based on summary study-level risk of bias, inconsistency, indirectness, imprecision, and publication bias. Therefore, to avoid prolonged fasting in children, efforts should be made to allow clear liquids in healthy children as close to 2h before procedures as possible. Preoperative carbohydrate loading in patients undergoing thoracic surgery: A quality-improvement project. Chewing gum, sucking hard candy on the morning of surgery may stimulate . Received from the American Society of Anesthesiologists, Schaumburg, Illinois. Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery. The mean age of participants was 43.2 yr, and 64% were female. asa npo guidelines 2020 chewing tobaccohershey high school homecoming 2019. Since nonhuman milk is similar to solids in gastric emptying time, consider the amount ingested when determining an appropriate fasting period. Both simple and complex carbohydratecontaining clear liquids were slightly more advantageous compared with noncaloric clear liquids in patient satisfaction. **, Strongly Agree: Median score of 5 (at least 50% of the responses are 5), Agree: Median score of 4 (at least 50% of the responses are 4 or 4 and 5), Equivocal: Median score of 3 (at least 50% of the responses are 3, or no other response category or combination of similar categories contain at least 50% of the responses), Disagree: Median score of 2 (at least 50% of responses are 2 or 1 and 2), Strongly Disagree: Median score of 1 (at least 50% of responses are 1). 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. Ask patients about tobacco use at every office visit. 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). Ingestion of glutamine and maltodextrin two hours preoperatively improves insulin sensitivity after surgery: A randomized, double blind, controlled trial. Patients chewing gum had a minimally increased residual gastric volume at anesthesia induction compared with fasting (table 6). Aspiration was not reported (strength of evidence not rated due to lack of events). The consultants agree and the ASA members strongly agree that for children and adults, 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. Three (30%) studies enrolled patients rated with ASA Physical Status I or II, and 1 (10%) study included ASA Physical Status I to III (6 [60%] studies did not report ASA Physical Status). Comparative trial of the effect of ranitidine and cimetidine on gastric secretion in fasting patients at induction of anaesthesia. Address correspondence to the American Society of Anesthesiologists: 1061 American Lane, Schaumburg, Illinois 60173. Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Inadequate literature cannot be used to assess relationships among clinical interventions and outcomes because a clear interpretation of findings is not obtained due to methodological concerns (e.g., confounding of study design or implementation) or the study does not meet the criteria for content as defined in the Focus of the guidelines. Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Metabolic profiles in children during fasting. Age limits It is illegal to sell or supply tobacco products to young people under the age of 18. Two studies received industry support, and 1 study noted author conflict of interest. Preoperative nutrition and postoperative discomfort in an eras setting: A randomized study in gastric bypass surgery. Potential inclusionexclusion discrepancies were also examined with an artificial intelligence tool, a component of the systematic review software. Postoperative inflammation and insulin resistance in relation to body composition, adiposity and carbohydrate treatment: A randomised controlled study. NPO Guidelines NPO Guidelines Guidelines for Adults and Teenagers Adults and teenagers over the age of 12 may have solid foods and dairy products until 8 hours before their scheduled arrival time at the hospital or surgery center. Although controlled studies do not sufficiently evaluate such relationships, the reported evidence does focus on intermediate outcomes, including gastric contents (e.g., volume or pH) and nausea and vomiting, typically considered by the authors to be representative of a predicted risk of pulmonary aspiration. American Society of Anesthesiologists Committee. The effect of intravenous pantoprazole and ranitidine for improving preoperative gastric fluid properties in adults undergoing elective surgery. Site Management asa npo guidelines 2020 chewing tobacco Download PDF 2 MB. 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. Influence of preoperative fasting time on maternal and neonatal blood glucose level in elective caesarean section under subarachnoid block. chewing tobacco npo guidelines. The body of evidence included 10 studies (7 randomized controlled trials,9297,187 1 crossover study,98 1 single-arm study,188 and 1 case series189) comparing chewing gum (sugar-free or sugared) with fasting, water, or lollipops. A preliminary study using real-time ultrasound. A difference was not detected in gastric pH between the groups. Site Management asa npo guidelines 2020 chewing tobacco Anesthesiology 2011 ; 114: 495-511. Copyright 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. Simple or complex carbohydratecontaining clear liquids appear to reduce hunger compared with noncaloric clear liquids. Preoperative oral carbohydrate administration to ASA IIIIV patients undergoing elective cardiac surgery. A study of preoperative fasting in infants aged less than three months. Although the literature is insufficient to evaluate the influence of preoperatively adding milk or milk products to clear liquids (e.g., tea or coffee) on either pulmonary aspiration, gastric volume, pH, or gastric emptying, some studies with healthy volunteer subjects have reported equivocal findings for gastric volume and gastric emptying when these products are added to clear liquids.5254.
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