Fasting

Aspiration is a rare complication of procedural sedation. [2,5]

In ED, patients may require emergency or urgent procedures when this is often not possible to delay the procedure. Emergency clinicians should undertake a risk assessment taking into account dynamic risk factors for aspiration e.g., alcohol ingestion, established risk factors e.g., obesity, pregnancy, proposed sedation agent (e.g., ketamine helps preserve airway reflexes; propofol reduces airway reflexes) and the procedure to be performed. [6]

There is no clear evidence that non-compliance with elective fasting guidance increases the risk of aspiration or other adverse events during procedural sedation; generally, concerns about aspiration vastly exceed the actual risk. [6]