Incidence of excessive preoperative fasting: a prospective observational study

Editor—Preoperative fasting is a standard procedure before surgery that aims to prevent pulmonary aspiration. However, consequences of excessive preoperative fasting include dehydration, reduced patient comfort, increased postoperative insulin resistance, and increased catabolic response to surgery.1,2 Current preoperative fasting guidelines advise that adults should fast 6 h for solids and 2 h for clear fluids, the 6–2 hour rule.3,4 Children should fast 6 h for solids, 4 h for human milk, and 1 h for clear fluids (the 6–4–1 hour rule).