2026 ESAIC Guidelines on preoperative fasting in adults: clinical practice guidelines protocol with EAES participation

BACKGROUND – Preoperative fasting aims to reduce pulmonary aspiration risk during anaesthesia. However, actual fasting durations often exceed recommendations, leading to patient discomfort, thirst and anxiety. Liberal fasting protocols may improve patient well-being without increasing aspiration risk, while gastric ultrasound may help identify patients with a higher risk of aspiration. OBJECTIVES – This guideline aims to provide evidence-based recommendations on preoperative fasting duration for clear fluids and the use of gastric ultrasound assessment in adults undergoing elective procedures. METHODS – A multidisciplinary task force will address two questions: (1) Should adults follow liberal (0–2 h) instead of standard (2–4 h) fasting for clear fluids before elective anaesthesia? (2) Should ultrasound be routinely used to assess gastric content before elective anaesthesia? Two systematic reviews will be conducted, as well as systematic searches to identify evidence on patient values and contextual factors. Evidence certainty will be rated using GRADE, and recommendations will be developed through evidence-to-decision frameworks considering benefits, harms, patient values, resources, acceptability, feasibility and equity. CONCLUSIONS – This guideline aims to provide evidence-based recommendations on the duration of preoperative fasting for clear fluids and the use of gastric ultrasound to assess gastric content before anaesthesia for elective procedures in adults.