Preoperative fasting for adults to prevent perioperative complications

Marian C Brady; Sue Kinn; Pauline Stuart; Valerie Ness

doi:10.1002/14651858.CD004423

Table 1. Guidelines for Adults Fasting

Solids	Clear Fluids	Other Fluids
6hrs * ¥	2hrs * ¥ 3hrs Goresky Maltby (1990) 5hrs ‡ Oral premedication + 150mls water up to 1hr ¥	2hrs *
KEY	hrs = recommended duration of preoperative fasting measured in hours	* = American Society of Anesthesiologists ‡ = Canadian Anaesthestists' Society ¥ = Norwegian national consensus guidelines for preoperative fasting in elective surgery

Table 1. Guidelines for Adults Fasting

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Table 2. The ASA Physical Status Classification System

Class I	Class II	Class III	Class IV	Class V	Class VI
A normally healthy patient	A patient with mild systemic disease	A patient with severe systemic disease	A patient with severe systemic disease that is a constant threat to life	A moribund patient who is not expected to survive 24hrs without the operation	A declared brain‐dead patient whose organs are being removed (for) donor purposes

Table 2. The ASA Physical Status Classification System

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Table 3. Search strategy for electronic databases

Database	Strategy
Medline 1966 ‐ August 2003	1. (randomized‐controlled‐trial or meta‐analysis or controlled clinical trial).pt. 2. (Random$ or meta‐anal$ or metaanaly$ or meta analy$).tw 3. ((doubl$ or singl$) and blind$).tw. 4. exp Clinical‐Trials/ 5. crossover.ti,ab,tw,mp. 6. 1 or 2 or 3 or 4 or 5 7. child$.mp. 8. (Anesth$ or Anaesth$).af. 9. anesthesia/ or anesthesiology/ or anaesthesia/ or anaesthesiology/ 10. Anesthesia, Conduction/ or anesthesia, general/ or anesthetics inhalation/ or anesthetics dissociative/ or anesthesia intratracheal/ or anesthesia intravenous/ or anesthesia closed circuit/ or anesthesia obstetrical/ or anesthesia, recovery period/ or anesthesia, dental/ or anesthesia department, hospital/ or anesthesia inhalation/ or adjuvants, anesthesia/ or intra operative complications.mp. 11. exp Anesthesia, Conduction/ or exp anesthesia, general/ or exp anesthetics inhalation/ or exp anesthetics dissociative/ or exp anesthesia intratracheal/ or exp anesthesia intravenous/ or exp anesthesia closed circuit/ or exp anesthesia obstetrical/ or exp anesthesia, recovery period/ or exp anesthesia, dental/ or exp anesthesia department, hospital/ or exp anesthesia inhalation/ or exp adjuvants, anesthesia/ 12. (preop$ or pre‐op$ or presurg$ or pre‐surg$ or preanaest$ or pre‐anaest$ or preanest$ or pre‐anest$).af. 13. 8 or 9 or 10 or 11 or 12 14. (fast$ or starv$).af. 15. 13 and 14 and 6 16. 15 not 7 17. Limit 16 to human 18. (fluid$ or drink$ or digest$ or intake or hydrat$).af. 19. 18 and 13 and 6 20. 19 not 7 21. Limit 20 to human 22. (food or eat$ or nutrition).mp. 23. 22 and 13 and 6 24. 23 not 7 25. Limit 24 to human 26. (thirst$ or hung$).mp. 27. 26 and 13 and 6 28. 27 not 7 29. Limit 28 to human 30. (preoperative fast$ or pre‐operative fast$).af. 31. 30 not 7 32. Limit 31 to human 33. (Nil by mouth or NPO or Nulla per os or Nothing by mouth).af. 34. 33 not 7 35. Limit 34 to human 36. PNEUMONIA/ or PNEUMONIA, ASPIRATION/ or PNEUMONIA, BACTERIAL/ or PNEUMONIA, LIPID/ or PNEUMONIA, MYCOPLASMA 37. (pneumonia or acid aspiration).af 38. RISK/ or RISK ASSESSMENT/ or RISK FACTORS/ or RISK MANAGEMENT/ 39. 36 or 37 or 38 40. 39 and 13 and 6 41. 40 not 7 42. Limit 41 to human 43. Hydrogen‐Ion Concentration/ 44. exp gastric juice/ or exp stomach/ 45. (ph or volume).mp. 46. exp intraoperative complications/ or exp postoperative complications/ or exp preoperative care/ or administration, oral.mp. 47. (preoperative care or postoperative complications or intraoperative complications).af. 48. 43 or 44 or 45 49. 46 or 47 50. 48 and 49 and 13 and 6 51. 50 not 7 52. Limit 51 to human 53. 21 or 25 or 29 or or 32 or 35 or 42 or 52
CINAHL 1982‐to August 2003	1. (randomized‐controlled‐trial or meta‐analysis or controlled clinical trial).pt. 2. (Random$ or meta‐anal$ or metaanaly$ or meta analy$).tw 3. ((doubl$ or singl$) and blind$).tw. 4. exp Clinical‐Trials/ 5. crossover.ti,ab,tw,mp. 6. 1 or 2 or 3 or 4 or 5 7. child$.mp. 8. (Anesth$ or Anaesth$).af. 9. anesthesia/ or anesthesiology/ or anaesthesia/ or anaesthesiology/ 10. Anesthesia, Conduction/ or anesthesia, general/ or anesthetics inhalation/ or anesthetics dissociative/ or anesthesia intratracheal/ or anesthesia intravenous/ or anesthesia closed circuit/ or anesthesia obstetrical/ or anesthesia, recovery period/ or anesthesia, dental/ or anesthesia department, hospital/ or anesthesia inhalation/ or adjuvants, anesthesia/ or intra operative complications.mp. 11. (preop$ or pre‐op$ or presurg$ or pre‐surg$ or preanaest$ or pre‐anaest$ or preanest$ or pre‐anest$).af. 12. 8 or 9 or 10 or 11 13. (fast$ or starv$).af. 14. 12 and 13 15. 14 not 7 16. (fluid$ or drink$ or digest$ or intake or hydrat$).af. 17. 16 and 12 18. 17 not 7 19. (food or eat$ or nutrition).mp. 20. 19 and 12 21. 20 not 7 22. (thirst$ or hung$).mp. 23. 22 and 12 24. 23 not 7 25. (preoperative fast$ or pre‐operative fast$).af. 26. 25 not 7 27. (Nil by mouth or NPO or Nulla per os or Nothing by mouth).af. 28. 27 not 7 29. pneumonia/ or pneumonia, aspiration/ or pneumonia, bacterial/ or pneumonia, lipid/ or pneumonia, mycoplasma 30. (pneumonia or aspiration).af 31. risk/ or risk assessment/ or risk factors/ or risk management/ 32. 29 or 30 or 31 33. 32 and 12 and 6 34. 33 not 7 35. Hydrogen‐Ion Concentration/ 36. Stomach/ 37. (gastric or stomach or ph or volume).mp. 38. Exp intraoperative complications/ or exp postoperative complications/ or exp preoperative care/ 39. (preoperative care or postoperative complications or intraoperative complications).af. 40. 35 or 36 or 37 41. 38 or 39 42. 40 and 41 and 12 43. 42 not 7 44. 15 or 18 or 21 or 24 or 26 or 28 or 34 or43
Cochrane Central Register of Controlled Trials	as for Medline

Table 3. Search strategy for electronic databases

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Table 4. Details of Quality Evaluation by Trial

Trial Reference	Participants	Inclusion criteria	Exclusion criteria	A priori sample size	Random Sequence	Allocation Conceal	Group Comparability	Blinding	ITT analysis
Agarwal 1989	100 participants in two arms	Listed	Listed	Not Reported	Adequate	Unknown	Yes (age, weight)	Adequate	No (six participants no pH values reported).
Gilbert 1995	100 participants in two arms	Listed	Listed	Not Reported	Unknown	Unknown	Yes (age, sex, duration and type of surgery)	N/A subjective outcome measures only	No (four IV fluids, 1 did not drink all of allocated drink)
Goodwin 1991	100 female participants in two arms	Listed	Listed	Not Reported	Unknown	Unknown	Yes (age, weight, parity)	N/A secondary outcome measures only	No (one exclusion ‐ vomited preinduction)
Hausel 2001 (published and unpublished information)	252 participants in three arms	Listed	Listed	Not Reported	Adequate	Adequate	Yes (age, sex, BMI)	Adequate	No (seven withdrawals from gastric volume measure. Gastric pH values for subset of 142 participants).
Hutchinson 1988 (published and unpublished information)	300 participants in six arms	Listed	Listed	Not Reported	Adequate	Inadequate	Yes (age, weight)	Adequate	No (37 participants no gastric pH measure)
Lam 1993 (published and unpublished information)	100 participants in two arms	Listed	Listed	Not Reported	Inadequate	Inadequate	Yes (age, weight, time post delivery)	Adequate	Not reported (no withdrawals)
Maltby 1986 (published and unpublished information)	140 participants in four arms	Listed	Listed	Not Reported	Adequate	Inadequate	Yes (age, weight, gestation, fasting interval, ingestion‐surgery interval)	Adequate	No (18 participants no gastric pH values)
Maltby 1988 (published and unpublished information)	60 participants in two arms	Listed	Listed	Not Reported	Adequate	Inadequate	Yes (age, weight, duration of overnight fast)	Adequate	No (Five participants withdrawn. Ingestion ‐ sample time too great).
Maltby, Pytka (unpublished information)	130 participants in two arms	Listed	Listed	Not Reported	Adequate	Inadequate	Yes (age, sex, weight, BMI)	Adequate	Not reported
McGrady 1988 (published and unpublished information)	50 participants in two arms	Listed	Listed	Not Reported	Adequate	Adequate	No (weight fluid group > than fast group)	Adequate	No (two protocol deviations (surgery cancelled, no premeds, one not possible to pass orogastric tube, three pharmacological co‐intervention and later excluded).
Miller 1983	45 participants in four arms	Listed	Listed	Not Reported	Unknown	Unknown	Yes (age, duration of surgery)	Adequate	No (15 participants no gastric aspirate)
Phillips 1993	100 participants in two arms	Listed	Listed	Not Reported	Inadequate (alternate weeks)	Inadequate	Yes	Adequate	Not reported (no withdrawals. Additional participant reported in thirst outcome)
Read 1991 (published and unpublished information)	53 participants in two arms	Listed	Listed	Not Reported	Partial	Unknown	Yes (age, weight, sex, surgery speciality)	Adequate	Not reported (17 follow‐up VAS scores lost due to early discharge (2 completed via nursing notes), 2 VAS completion violations, 3 VAS not returned)
Samaan 1989	180 participants in six arms	Listed	Listed (unpublished)	Not Reported	Unknown	Unknown	Yes (age, weight, fasting interval, pretreatment to sampling)	Adequate	No (33 participants no gastric content values available due to difficulties collecting sample)
Somwanshi 1995	40 participants in two arms	Listed	Listed	Not Reported	Unknown	Unknown	Yes (age, weight, fast)	Adequate	Not reported (no withdrawals)
Søreide 1993 (published and unpublished information)	75 participants in three arms	Listed	Listed	Not Reported	Adequate	Inadequate	Yes (age, weight, height, fast time, ingestion inducation time)	Adequate	Not reported (no withdrawals)
Splinter 1991	152 participants in two arms	Listed	Listed	Not Reported	Unknown	Unknown	Yes (age, weight, percentage inpatients)	Adequate	Not reported (no withdrawals reported).
Sutherland 1987 (published and unpublished information)	100 participants in four arms	Listed	Listed	Not Reported	Adequate	Inadequate	Yes (age, weight, fast)	Adequate	Not reported (13 participants no gastric pH measurement)
Tanabe 1996	40 participants in two arms	Listed	Listed	Not Reported	Unknown	Unknown	Yes (age, sex, height, weight, fasting period)	Unknown	Not reported (no withdrawals)
Tanabe 1997	40 participants in two arms	Listed	Listed	Not Reported	Unknown	Unknown	No (yes for age, sex, height, weight) Eating group shorter fasting period	Unknown	Not reported (no withdrawals).
Vincent 1991 (published and unpublished information)	60 participants in two arms	Listed	Listed	Not Reported	Adequate	Adequate	Yes between groups included in review (age, sex, weight, BMI, height, smokers)	Inadequate	No (seven withdrawals)
Yatsu 1996	45 participants in three arms	Listed	Listed	Not Reported	Unknown	Unknown	Yes (age, sex, height, weight)	Collection of gastric contents ‐ Inadequate	Not reported (no withdrawals)

Table 4. Details of Quality Evaluation by Trial

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Table 5. Summary Statistics ‐ Gastric Volume ‐ Intervention Groups

Trial ref	No. of participants	Mean	Standard Deviation	Median	Minimum	Maximum	Std. Error of Mean	Pseudo‐Mean	Pseudo‐Std Deviation
Hausel 2001a	84	28.00	35.00	20.00	0.00	287.00
Hausel 2001b	78	32.00	37.00	20.00	0.00	245.00
Hausel 2001c	84	28.00	35.00	20.00	0.00	287.00
Maltby Ptyka	63	48.00	43.00	30.00	3.00	187.00
Agarwal 1989	50	20.60	14.10		0.00	50.00
Hutchinson 1988a	50	24.50	21.60		0.00	96.00
Hutchinson 1988b	50	23.70	18.40		0.00	76.00
Hutchinson 1988c	50	14.30	15.40		0.00	68.00
Hutchinson 1988d	50	14.80	17.00		0.00	75.00
Hutchinson 1988e	50	23.70	18.40		0.00	76.00
Hutchinson 1988f	50	14.80	17.00		0.00	75.00
Maltby 1986a	35	17.60	14.50		0.00	56.00
Maltby 1986b	35	8.30	7.30		0.00	24.00
Miller 1983a	13	12.30	16.80		0.00	58.00
Miller 1983b	10	10.90	12.80		0.00	43.00
Sutherland 1987a	25	20.60	14.10		0.00	50.00
Sutherland 1987b	25	10.00	8.80		0.00	42.00
Splinter 1991	76	25.76	21.84		1.20	82.32
Vincent 1991	19	14.00	13.076		0.00	40.00	3.00
Søreide 1993a	25	23.00	20.00
Søreide 1993b	25	23.00	20.00
Søreide 1993c	25	23.00	20.00
Somwanshi 1995	20	21.90	8.49
Tanabe 1996	20	17.10	18.40
Tanabe 1997	20	19.20	16.30
Yatsu 1990a	15	8.00	6.00
Yatsu 1990b	15	6.30	6.00
Yatsu 1990c	15	8.00	6.00
Read 1991	25	24.20		21.00	0.00	70.00		*	*
McGrady 1988	23	22.57 (from reported raw data)	16.63 (from reported raw data)	16.50	4.00	51.5
Maltby 1988	29	17.00			0.00	131.00		16.970	9.785
Phillips 1993	50	21.00			0.00	80.00		20.997	12.242
Samaan 1989a	27	24.00			5.00	58.00		24.028	14.025
Samaan 1989b	25	13.00			1.00	36.00		13.031	7.549
Samaan 1989c	21	10.00			2.00	30.00		9.999	5.744
Lam 1993	50	25.50			3.00	66.00		25.493	14.733
								* = remains to be calculated

Table 5. Summary Statistics ‐ Gastric Volume ‐ Intervention Groups

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Table 6. Summary Statistics ‐ Gastric Volume ‐ Control Group

Trial ref	No. of Participants	Mean	Standard Deviation	Median	Minimum	Maximum	Std. Error of Mean	Pseudo‐Mean	Pseudo‐Std Deviation
Hausel 2001a	83	28.00	23.00	22.00	1.00	103.00
Hausel 2001b	83	28.00	23.00	22.00	1.00	103.00
Hausel 2001c	78	32.00	37.00	20.00	0.00	245.00
Maltby Ptyka	63	29.00	20.00	26.00	3.00	107.00
Agarwal 1989	50	29.90	18.20		0.00	75.00
Hutchinson 1988a	50	23.20	17.30		0.00	75.00
Hutchinson 1988b	50	23.20	17.30		0.00	75.00
Hutchinson 1988c	50	9.70	12.6		0.00	62.00
Hutchinson 1988d	50	9.70	12.6		0.00	62.00
Hutchinson 1988e	50	24.50	21.60		0.00	96.00
Hutchinson 1988f	50	14.30	14.30		0.00	68.00
Maltby 1986a	35	26.70	18.90		0.00	80.00
Maltby 1986b	35	9.50	7.70		0.00	35.00
Miller 1983a	11	13.10	16.10		0.00	55.00
Miller 1983b	11	8.80	13.50		0.00	42.00
Sutherland 1987a	25	29.90	18.20		2.00	75.00
Sutherland 1987b	25	9.70	10.50		0.00	42.00
Splinter 1991	76	28.80	24.00		1.20	126.60
Vincent 1991	34	11.00	11.661		0.00	60.00	2.00
Søreide 1993a	25	31.00	30.00
Søreide 1993b	25	31.00	30.00
Søreide 1993c	25	23.00	20.00
Somwanshi 1995	20	22.55	8.30
Tanabe 1996	20	6.40	8.50
Tanabe 1997	20	20.90	18.30
Yatsu 1990a	15	10.90	7.90
Yatsu 1990b	15	10.90	7.90
Yatsu 1990c	15	6.30	6.00
Read 1991	29	25.70		23.00	0.00	115.00
McGrady 1988	21	27.83 (from raw data reported in paper)	17.60 (from raw data reported in paper)	25.00	0.00	58.00
Maltby 1988	28	13.00			0.00	70.00		13.042	7.562
Phillips 1993	50	19.00			0.00	63.00		18.953	10.997
Samaan 1989a	24	25.00			3.00	100.00		25.071	14.365
Samaan 1989b	26	11.00			2.00	29.00		10.992	6.325
Samaan 1989c	24	12.00			2.00	52.00		12.038	6.978
Lam 1993	50	22.00			1.00	78.00		21.982	12.723
								* = remains to be calculated

Table 6. Summary Statistics ‐ Gastric Volume ‐ Control Group

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Table 7. Summary Statistics ‐ Gastric pH ‐ Intervention Groups

Trial Ref	No. of Participants	Mean	Standard Deviation	Median	Minimum	Maximum	Std Error of Mean	Pseudo‐Mean	Pseudo‐Std Deviation
Maltby Ptyka	65	2.13	1.32	1.77	1.27	7.34
McGrady 1988	23	2.74 (from raw data reported in paper)	2.17 (from raw data reported in paper)	1.37	1.09	7.60
Agarwal 1989	46	2.05	1.41		1.21	5.82
Hausel 2001a	45	2.50	1.70		1.00	8.90
Hausel 2001b	40	2.60	1.50		1.00	7.80
Hausel 2001c	45	2.50	1.70		1.00	8.90
Hutchinson 1988a	49	2.18	1.58		1.17	7.60
Hutchinson 1988b	46	1.95	1.24		1.16	7.50
Hutchinson 1988c	42	5.65	2.12		1.59	9.16
Hutchinson 1988d	37	5.41	2.12		1.86	8.30
Hutchinson 1988e	46	1.95	1.24		1.16	7.50
Hutchinson 1988f	37	5.41	2.12		1.86	8.30
Maltby 1986a	35	1.75	0.94		0.75	6.50
Maltby 1986b	35	5.52	1.79		1.33	7.71
Splinter 1991	76	1.80	1.00		1.20	6.50
Sutherland 1987a	22	2.05	1.41		0.76	5.84
Sutherland 1987b	21	6.71	0.99		4.00	7.98
Vincent 1991	13	5.16	2.487		1.70	7.30	0.69
Somwanshi 1995	20	2.21	0.98
Søreide 1993a	25	1.50	0.30
Søreide 1993b	25	2.00	1.10
Søreide 1993c	25	1.50	0.30
Tanabe 1996	20	4.40	2.60
Tanabe 1997	20	4.60	2.30
Yatsu 1990a	15	6.20	2.40
Yatsu 1990b	15	7.10	1.70
Yatsu 1990c	15	6.20	2.40
Read 1991	25	1.76		1.65	1.24	3.46		1.858	0.949
Phillips 1991	50	2.64			1.07	6.82		2.644	1.523
Maltby 1988	23	3.44			1.68	7.32		3.433	1.983
Lam 1993	50			1.18	0.70	6.40		1.567	0.825
Miller 1983a	9			2.70	1.20	7.20		3.273	1.556
Miller 1983b	8			1.90	1.30	4.10		2.217	1.028
Samaan 1989a	27			1.60	1.30	3.20		1.799	0.922
Samaan 1989b	25			6.30	1.30	6.90		5.732	2.917
Samaan 1989c	21			6.30	1.50	7.90		5.811	2.937
								* = remains to be calculated

Table 7. Summary Statistics ‐ Gastric pH ‐ Intervention Groups

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Table 8. Summary Statistics ‐ Gastric pH ‐ Control Groups

Trial Ref	No. of Participants	Mean	Standard Deviation	Median	Minimum	Maximum	Std Error of Mean	Pseudo‐Mean	Pseudo‐Std Deviation
Maltby Ptyka	65	2.11	1.14	1.78	1.31	7.08
McGrady 1988	21	1.59 (from raw data reported in paper)	0.76 (from raw data reported in paper)	1.36	1.12	4.00
Agarwal 1989	48	1.85	1.26		1.17	1.17
Hausel 2001a	42	2.70	1.8		1.00	8.00
Hausel 2001b	42	2.70	1.8		1.00	8.00
Hausel 2001c	40	2.60	1.50		1.00	7.80
Hutchinson 1988a	49	1.95	1.26		1.17	7.72
Hutchinson 1988b	49	1.95	1.26		1.17	7.72
Hutchinson 1988c	40	6.21	1.51		1.78	7.77
Hutchinson 1988d	20**	6.21	1.51		1.78	7.77
Hutchinson 1988e	49	2.18	1.58		1.17	7.60
Hutchinson 1988f	42	5.65	2.12		1.59	9.16
Maltby 1986a	35	1.92	1.27		0.91	6.44
Maltby 1986b	35	5.03	1.79		1.64	7.51
Splinter 1991	76	1.60	0.40		1.20	3.00
Sutherland 1987a	25	1.72	0.33		0.95	2.33
Sutherland 1987a	19	6.31	1.81		1.50	7.95
Vincent 1991	20	5.78	1.923		1.90	8.00	0.43
Somwanshi 1995	20	2.18	0.88
Søreide 1993a	25	1.90	1.00
Søreide 1993b	25	1.90	1.00
Søreide 1993c	25	2.00	1.10
Tanabe 1996	20	6.00	2.20
Tanabe 1997	20	4.30	2.30
Yatsu 1990a	15	6.30	2.30
Yatsu 1990b	15	6.30	2.30
Yatsu 1990c	15	7.10	1.70
Read 1991	29	1.72		1.65	1.06	3.93		1.866	0.888
Phillips 1991	50	2.26			1.25	7.03		2.255	1.305
Maltby 1988	24	2.89			1.53	7.80		2.895	1.677
Lam 1993	50			1.19	0.74	4.57		1.447	0.764
Miller 1983a	8			2.70	1.40	6.20		3.120	1.527
Miller 1983b	5			6.30	1.50	6.90		5.095	2.952
Samaan 1989a	24			1.60	1.10	3.20		1.762	0.941
Samaan 1989b	26			6.20	2.00	8.50		5.995	2.967
Samaan 1989c	24			6.10	1.40	7.00		5.639	2.638
* = remains to be calculated

Table 8. Summary Statistics ‐ Gastric pH ‐ Control Groups

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Table 9. Alternative Pseudo‐Values ‐ Gastric Volume ‐ Intervention Groups

Trial	No. of Participants	Mean	Minimum	Maximum	Std Error of Mean	Pseudo‐Mean	Pseudo‐SD	Pseudo‐Mean (2)	Pseudo‐SD (2)
Maltby 1988	29	17.00	0.00	131.00		16.970	9.785	17.012	12.03
Phillips 1993	50	21.00	0.00			20.997	12.242	20.975	14.79
Samaan 1989a	27	24.00	5.00	58.00		24.028	14.025	24.007	16.967
Samaan 1989b	25	13.00	1.00	36.00		13.031	7.549	13.005	9.18
Samaan 1989c	21	10.00	2.00	30.00		9.999	5.744	9.987	7.057
Lam 1993	50	25.50	3.00	66.00		25.493	14.733	25.532	18.08

Table 9. Alternative Pseudo‐Values ‐ Gastric Volume ‐ Intervention Groups

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Table 10. Alternative Pseudo‐Values ‐ Gastric Volume ‐ Control Groups

Trial	No. of Participants	Mean	Minimum	Maximum	Std Error of Mean	Pseudo‐Mean	Pseudo‐Std Deviation	Pseudo‐Mean (2)	Pseudo‐SD (2)
Maltby 1988	28	13.00	0.00	70.00		13.042	7.562	12.995	9.161
Phillips 1993	50	19.00	0.00	63.00		18.953	10.997	18.999	13.406
Samaan 1989a	24	25.00	3.00	100.00		25.071	14.365	25.009	17.624
Samaan 1989b	26	11.00	2.00	29.00		10.992	6.325	11.009	7.804
Samaan 1989c	24	12.00	2.00	52.00		12.038	6.978	12.021	8.445
Lam 1993	50	22.00	1.00	78.00		21.982	12.723	21.987	15.563

Table 10. Alternative Pseudo‐Values ‐ Gastric Volume ‐ Control Groups

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Table 11. Alternative Pseudo‐Values ‐ Gastric pH ‐ Intervention Groups

Trial	No. of participants	Mean	Median (Std Error)	Minimum	Maximum	Pseudo‐Mean	Pseudo‐Std Deviation	Pseudo‐Mean (2)	Pseudo‐SD (2)
Phillips 1991	50	2.64		1.07	6.82	2.644	1.523	2.635	1.852
Maltby 1988	23	3.44		1.68	7.32	3.433	1.983	3.477	2.452

Table 11. Alternative Pseudo‐Values ‐ Gastric pH ‐ Intervention Groups

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Table 12. Alternative Pseudo‐Values ‐ Gastric pH ‐ Control Groups

Trial	No of Participants	Mean	Median	Minimum	Maximum (SEM)	Pseudo‐Mean	Pseudo‐Std Deviation	Pseudo‐Mean (2)	Pseudo‐SD (2)
Phillips 1991	50	2.26		1.25	7.03	2.255	1.305	2.256	1.592
Maltby 1988	24	2.89		1.53	7.80	2.895	1.677	2.884	2.042

Table 12. Alternative Pseudo‐Values ‐ Gastric pH ‐ Control Groups

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Table 13. Duration of Fast ‐ Secondary Outcome Measures

Comparison	Thirst	Hunger	Pain	Nausea	Vomiting	Anxiety
SHORTENED FLUID FAST v STANDARD FAST
Fluids up to 90 mins preoperatively
Soreide 1993 a/b	VAS	_	VAS	reported	reported	VAS
Fluids 120 ‐ 180 mins preoperatively
Agarwal 1989	NSMS	NSMS	_	noted	noted	_
Goodwin 1991	VAS	VAS	VAS	VAS	VAS	_
Hausel 2001a/b	VAS	VAS	VAS	VAS	_	_
Hutchinson 1988 a/b/c/d	NSMS	NSMS	_	_	_	_
Maltby 1986 a/b	NMME	NMME	_	_	_	_
Phillips 1993	NMMS	NMMS	_	_	_	_
Read 1991	VAS (x4)	_	_	Y/N	Y/N	VAS
Splinter 1991	VAS	VAS	_	_	_	_
Vincent 1991	_	_	_	_	noted	_
Yatsu 1996 a/b	VAS	VAS	_	_	_	_
Fluids up to 180 mins preoperatively
Gilbert 1995	VAS	VAS	_	VAS	VAS	BSW
SHORTENED SOLID FAST v SHORTENED FLUID FAST
Fluid + Breakfast v Fluid
Tanabe 1997	VAS	VAS	_	_	_	_

Table 13. Duration of Fast ‐ Secondary Outcome Measures

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Table 14. 'At Risk' Patient Populations ‐ Hunger

Trial	Patient Population	Measure	Time of Measure	Comparison	Result
Lam 1993	Women 5 days postpartum	NSS	(f)	1. Standard Fast (n = 50)2. Water [150mls] (n = 50)	No difference between groups' hunger ratings.

Table 14. 'At Risk' Patient Populations ‐ Hunger

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Table 15. Key to Secondary Outcome Data Tables

Key	Measure	Key	Measure	Key	Time of measure
NSMS	Nil ‐ Slight ‐ Moderate ‐ Severe	Y/N	Yes/No	(a)	> or = 1 day preoperatively
NMME	Nil ‐ Mild ‐ Moderate ‐ Extreme	noted	note taken of any occurrence	(b)	on admission
NMMS	Nil ‐ Mild ‐ Moderate ‐ Severe	reported	participant report	(c)	prerandomisation
BSW	Better ‐ Same ‐ Worse (than before admission and in comparison to other anaesthetics)	1‐4	1 to 4 Scale (1. Do not feel thirsty/hungry at all; 2. Thirsty/hungry but do not need any water/food; 3. Thirsty/hungry and want to drink/eat; 4. Unusually thirsty/hungry).	(d)	> or = 120 mins preoperatively
NSS	None ‐ Slight ‐ Severe	_	not measured	(e)	< 120 mins preoperatively
VAS	Visual Analogue Scale			(f)	preinduction/in operating room
				(g)	postoperatively

Table 15. Key to Secondary Outcome Data Tables

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Table 16. Duration of Fast ‐ Aspiration/Regurgitation

Trial	Method	Measure	Comparison	Result
Shortened Fluid Fast v Standard Fast
Fluids up to 90 mins preoperatively
Søreide 1993 a	unclear	aspiration/regurgitation	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	No aspiration/regurgitation
Søreide 1993 b	unclear	aspiration/regurgitation	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No aspiration/regurgitation
Fluids 120 ‐ 180 mins preoperatively (no H2 receptor‐antagonist)
Goodwin 1991	unclear	regurgitation	1. Standard Fast (n = 49) 2. 50 Water/Orange drink [150mls] (n = 50)	No regurgitation in fluid group
Hausel 2001a	unclear	apparent or suspected aspiration/other drink‐related complications pre‐, intra‐ or post‐operatively.	1. Standard Fast (n = 86) 2. Water [800ml evening before surgery and 400mls 2hrs preop] (n = 80)	No aspiration/other drink‐related complications
Hausel 2001b	unclear	apparent or suspected aspiration/other drink‐related complications pre‐, intra‐ or post‐operatively.	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400mls 2hrs preop] (n = 86)	No aspiration/other drink‐related complications
Phillips 1993	noted	aspiration/regurgitation	1. Standard Fast (n = 50) 2. Clear Fluids [unrestricted] (n = 50)	No aspiration/regurgitation
Fluids up to 180 mins preoperatively (+ H2‐Receptor Antagonist)
Gilbert 1995	noted	'adverse events' and 'associated morbidity'	1. Standard Fast + Randitine [150mg] (n = 49) 2. Water [500‐1000mls] + Randitine [150mg] (n = 46)	No 'adverse events'

Table 16. Duration of Fast ‐ Aspiration/Regurgitation

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Table 17. Type of Intake ‐ Aspiration/Regurgitation

Trial	Method	Measure	Comparison	Result
Water v Standard Fast
Søreide 1993 a	unclear	aspiration/regurgitation	1. Standard Fast (n = 25)2. Water [150mls] (n = 25)	No aspiration/regurgitation
Søreide 1993 b	unclear	aspiration/regurgitation	1. Standard Fast (n = 25)2. Water [300‐450mls] (n = 25)	No aspiration/regurgitation
Hausel 2001a	unclear	apparent or suspected aspiration/other drink‐related complications pre‐, intra‐ or post‐operatively.	1. Standard Fast (n = 86)2. Water [800ml evening before surgery and 400mls 2hrs preop] (n = 80)	No aspiration/other drink‐related complications
Gilbert 1995	noted	'adverse events' and 'associated morbidity'	1. Standard Fast + Randitine [150mg] (n = 49)2. Water [500‐1000mls] + Randitine [150mg] (n = 46)	No 'adverse events'
Other Fluids v Standard Fast
Goodwin 1991	unclear	regurgitation	1. Standard Fast (n = 49)2. 50 Water/Orange drink [150mls] (n = 50)	No regurgitation in fluid group
Hausel 2001b	unclear	apparent or suspected aspiration/other drink‐related complications pre‐, intra‐ or post‐operatively.	1. Standard Fast (n = 86)2. Carbohydrate drink [800ml evening before surgery and 400mls 2hrs preop] (n = 86)	No aspiration/other drink‐related complications
Phillips 1993	noted	aspiration/regurgitation	1. Standard Fast (n = 50)2. Clear Fluids [unrestricted] (n = 50)	No aspiration/regurgitation
Water [F1] v Carbohydrate Drink [F2]
Hausel 2001c	unclear	apparent or suspected aspiration/other drink‐related complications pre‐, intra‐ or post‐operatively.	1. Water (n = 80)2. Carbohydrate drink (n = 86)	No aspiration/other drink‐related complications

Table 17. Type of Intake ‐ Aspiration/Regurgitation

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Table 18. Volume of Intake ‐ Aspiration/Regurgitation

Trial	Method	Measure	Comparison	Results
Low Volume Fluid Intake v Standard Fast
Søreide 1993 a	unclear	aspiration/regurgitation	1. Standard Fast (n = 25)2. Water [150mls] (n = 25)	No aspiration/regurgitation
Goodwin 1991	unclear	regurgitation	1. Standard Fast (n = 49)2. 50 Water/Orange drink [150mls] (n = 50)	No regurgitation in fluid group
High Volume Fluid Intake v Standard Fast
Søreide 1993 b	unclear	aspiration/regurgitation	1. Standard Fast (n = 25)2. Water [300‐450mls] (n = 25)	No aspiration/regurgitation
Hausel 2001a	unclear	apparent or suspected aspiration/other drink‐related complications pre‐, intra‐ or post‐operatively.	1. Standard Fast (n = 86)2. Water [800ml evening before surgery and 400mls 2hrs preop] (n = 80)	No aspiration/other drink‐related complications
Hausel 2001b	unclear	apparent or suspected aspiration/other drink‐related complications pre‐, intra‐ or post‐operatively.	1. Standard Fast (n = 86)2. Carbohydrate drink [800ml evening before surgery and 400mls 2hrs preop] (n = 86)	No aspiration/other drink‐related complications
Gilbert 1995	noted	'adverse events' and 'associated morbidity'	1. Standard Fast + Randitine [150mg] (n = 49)2. Water [500‐1000mls] + Randitine [150mg] (n = 46)	No 'adverse events'
Unlimited Fluid Intake v Standard Fast
Phillips 1993	noted	aspiration/regurgitation	1. Standard Fast (n = 50)2. Clear Fluids [unrestricted] (n = 50)	No aspiration/regurgitation
Low v High Volume Fluid Intake
Søreide 1993 c	unclear	aspiration/regurgitation	1. Water [150mls] (n = 25) 2. Water [300‐450mls] (n = 25)	No aspiration/regurgitation

Table 18. Volume of Intake ‐ Aspiration/Regurgitation

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Table 19. 'At‐Risk' Patient Populations ‐ Aspiration/Regurgitation

Trial	Patient Population	Method	Measure	Comparison	Result
Postpartum
Somwanshi	women 1 to 4 days postpartum	unclear	aspiration/regurgitation	1. Water [150mls] (n = 20) 2. Standard Fast (n = 20)	No aspiration or regurgitation

Table 19. 'At‐Risk' Patient Populations ‐ Aspiration/Regurgitation

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Table 20. Shortened Fluid Fast v Standard Fast ‐ Thirst

Trial	Measurement	Time of Measurement	Comparison	Result
Fluids up to 90 mins preoperatively
Søreide 1993a	VAS x 2Thirst Dry mouth	(b), (f), (g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Both groups recorded decreased thirst and dryness of mouth between (b) and (f). Reduction tended to be greater in Water group than Standard Fast (p = 0.08). At (g) no differences between groups.
Søreide 1993b	VAS x 2Thirst Dry mouth	(b), (f), (g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	Both groups recorded decreased thirst and dryness of mouth between (b) and (f). Reduction tended to be greater in Water group than Standard Fast (p = 0.08). At (g) no differences between groups.
Fluids 120 ‐ 180 mins preoperatively (no H2‐Receptor Antagonists)
Agarwal 1989	NSMS	(d), (f)	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	Water group had more decreased thirst ratings than Standard Fast group (p < 0.05). More Standard Fast group recorded increased levels of thirst than Water group (p < 0.05)
Goodwin 1991	LAS	(c), (f)	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	Water/Orange group recorded reduced and the Standard Fast group increased thirst scores at (f) compared to (c) (p = <0.001). The Water/Orange group's thirst scores at (f) significantly lower than scores of Standard Fast group (p < 0.001).
Hausel 2001a	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening b4 and 400ml 2hrs preop (n = 86)	Standard Fast group increased thirst over time. Water group had no significant change in thirst levels over time but were significantly less thristy than Standard Fast group.
Hausel 2001b	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	The Standard Fast group rated their thirst as increasing over the preoperative period while the Carbohydrate group reported decreasing thirst scores. At the three time points (d) and (e x 2) the Carbohydrate group rated their thirst as significantly less than the thirst ratings made by the Standard Fast group.
Hutchinson 1988a	NSMS	(c), (f)	1. Standard Fast + placebo (n = 50) 2. Coffee [150mls] (milk permitted) + placebo (n = 50)	More Coffee group reduced thirst scores over time (c‐f) than the Standard Fast group (p< 0.001). More Standard Fast group recorded greater thirst scores over time (c‐f) than the Coffee group (p< 0.001).
Hutchinson 1988b	NSMS	(c), (f)	1. Standard Fast + placebo (n = 50) 2. Orange Juice [150mls] + placebo (n = 50)	More Orange Juice group reduced thirst ratings over time (c‐f) than the Standard Fast group (p< 0.001). More Standard Fast group recorded greater thirst scores over time (c‐f) than the intervention group (p< 0.001).
Maltby 1986a	NMME	(b), (f)	1. Standard Fast + placebo (n = 35) 2. Water [150 ml] + placebo (n = 35)	Water group at (f) recorded lower thirst scores than at (b). No other reported differences
Phillips 1993	NMMS	(f)	1. Standard Fast (n = 50) 2. Clear Fluids [unlimited] (n = 50)	Clear Fluids group rated thirst as less severe than Standard Fast group (p < 0.001).
Read 1991	VAS (x4)	(c)1. Normal degree of 'thirstiness';2. Usual dryness of mouth;(e)3. Current dryness of mouth.(g ‐1 day)4. Satisfaction with fluid management	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	1. No difference between groups.2. No difference between groups.3. No difference between groups.4. No difference between groups.
Fluids 120 ‐ 180 mins preoperatively (+ H2‐Receptor Antagonists)
Hutchinson 1988c	NSMS	(c), (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Coffee [150mls] (milk permitted) + Ranitidine [150mg] (n = 50)	More Coffee group had reduced thirst scores at (f) from scores at (c) than the Standard Fast group. More of the Standard Fast group increased their thirst scores overtime than the Coffee group.
Hutchinson 1988d	NSMS	(c), (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Orange Juice [150mls] + Ranitidine [150mg] (n = 50)	More Orange Juice group had reduced thirst scores at (f) from scores at (c) than the Standard Fast group. More of the Standard Fast group increased their thirst scores overtime than the Orange Juice group.
Maltby 1986b	NMME	(b), (f)	1. Standard Fast + Ranitidine [150mg] (n = 35) 2. Water [150 ml] + Ranitidine [150mg] (n = 35)	Water group at (f) recorded lower thirst scores than at (b). No other reported differences
Yatsu 1996a	VAS	(f)	1. Standard Fast + Roxatidine [75mg x2] (n = 15) 2. Water [150mls] + Roxatidine [75mg x2] (n = 15)	No difference between groups.
Yatsu 1996b	VAS	(f)	1. Standard Fast + Roxatidine [75mg x2] (n = 15) 2. Isotonic Drink [150mls] + Roxatidine [75mg x2] (n = 15)	No difference between groups.
Fluids > 180 mins preoperatively (No H2‐Receptor Antagonists)
Splinter 1991	VAS	(f)	1. Standard Fast (n = 76) 2. Clear Fluids [unlimited] (n = 76)	Clear Fluids group recorded lower thrist scores than the Standard Fast group (p < 0.05).
Fluids > 180 mins preoperatively (+ H2‐Receptor Antagonists)
Gilbert 1995	VAS	(g)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water + Ranitidine [150mg] (500 ‐1000ml) (n = 46)	Water group reported lower thirst scores than Standard Fast group (p= 0.015).

Table 20. Shortened Fluid Fast v Standard Fast ‐ Thirst

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Table 21. Shortened Fluid Fast v Standard Fast ‐ Hunger

Trial	Measure	Time of Measure	Comparison	Result
Fluid 120‐180 mins preoperatively (No H2‐Receptor Antagonist)
Agarwal 1989	NSMS	(c) (f)	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	Water group had more decreased hunger ratings over time than Standard Fast group (p < 0.05).
Goodwin 1991	LAS	(c) (f)	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	No difference between groups. Increase in preoperative hunger within both groups (p< 0.01).
Hausel 2001a	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	Standard Fast group increased hunger scores over preoperative time. Water group hunger ratings unchanged over time. No difference between groups' hunger ratings.
Hausel 2001b	VAS	(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	Standard Fast group scored higher hunger scores over preoperative time while the Carbohydrate group scored lower hunger scores overtime. At time points (d) and (ex2) the Carbohydrate group's hunger ratings were lower than the Fast group's.
Hutchinson 1988a	NSMS	(c) (f)	1. Standard Fast + placebo (n = 50) 2. Coffee [150mls] (milk permitted) + placebo (n = 50)	Coffee group had more decreased hunger ratings over time the Standard Fast group (p < 0.001).
Hutchinson 1988b	NSMS	(c) (f)	1. Standard Fast + placebo (n = 50) 2. Orange Juice [150mls] + placebo (n = 50)	Orange Juice group had more decreased hunger ratings over time than the Standard Fast group (p < 0.001).
Maltby 1986a	NMME	(b) (f)	1. Standard Fast + placebo (n = 35) 2. Water [150 ml] + placebo (n = 35)	No difference in hunger ratings within groups overtime.
Phillips 1993	NMMS	(f)	1. Standard Fast (n = 50) 2. Clear Fluids [unlimited] (n = 50)	No difference between groups (p = 0.09).
Fluid 120‐180 mins preoperatively (+ H2‐Receptor Antagonist)
Hutchinson 1988c	NSMS	(c) (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Coffee [150mls] (milk permitted) + Ranitidine [150mg] (n = 50)	No difference between groups.
Hutchinson 1988d	NSMS	(c) (f)	1. Standard Fast + Ranitidine (n = 50) 2. Orange Juice [150mls] + Ranitidine [150mg] (n = 50)	No difference between groups.
Maltby 1986b	NMME	(b) (f)	1. Standard Fast + Ranitidine [150mg] (n = 35) 2. Water [150 ml] + Ranitidine [150mg] (n = 35)	No difference in hunger ratings within groups overtime.
Yatsu 1996a	VAS	(f)	1. Standard Fast + Roxatidine [75mg x2] (n = 15) 2. Water [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups' hunger ratings.
Yatsu 1996b	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Isotonic Drink [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups' hunger ratings.
Fluids up to 180 mins preoperatively (no H2‐Receptor Antagonists)
Splinter 1991	VAS	(f)	1. Standard Fast (n = 76) 2. Clear Fluids [unlimited] (n = 76)	No difference between groups.
Fluids up to 180 mins preoperatively (+ H2‐Receptor Antagonists)
Gilbert 1995	VAS	(g)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water + Ranitidine [150mg] (500 ‐1000ml) (n = 46)	No difference between groups' hunger ratings (p = 0.90).

Table 21. Shortened Fluid Fast v Standard Fast ‐ Hunger

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Table 22. Shortened Fluid Fast v Standard Fast ‐ Pain

Trial	Measure	Method	Time of Measure	Comparison	Result
Fluids up to 90 mins preoperatively
Søreide 1993 a	Sore Throat	VAS	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	No differences.
Søreide 1993 b	Sore Throat	VAS	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No differences.
Fluids 120‐180 mins preoperatively
Goodwin 1991	Pain	VAS	(g)(x6) 30, 60, 120mins; on arrival at home; 12hrs; 24hrs post op.	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	Low scores. No difference except at 60 mins post surgery Standard Fast < pain than Water/Orange group (p < 0.05).
Hausel 2001a	Pain	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	No differences.
Hausel 2001b	Pain	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	No differences.

Table 22. Shortened Fluid Fast v Standard Fast ‐ Pain

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Table 23. Shortened Fluid Fast v Standard Fast ‐ Nausea

Trial	Method	Assessor	Time of Measure	Comparison	Result
Fluids up to 90 mins preoperatively
Søreide 1993a	Y/N	patient report	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	No difference. Standard Fast = 1 patient reported nausea. Fluid group = 2 patients reported nausea.
Søreide 1993b	Y/N	patient report	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No difference. Standard Fast = 1 patient reported nausea. Fluid group = 1 patient reported nausea.
Fluids 120‐180 mins preoperatively
Agarwal 1989	Noted	unclear	(e ‐ f) post premedication	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	None observed
Goodwin 1991	VAS	patient completed	(gx6)30; 60; 120 mins; on arrival at home; 12hrs; 24 hrs.	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	No difference. Low scores.
Hausel 2001a	VAS	patient completed	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening b4 and 400ml 2hrs preop (n = 86)	No difference over time in the Standard Fast group's ratings of nausea but increased ratings of nausea over time by the Water group.
Hausel 2001b	VAS	patient completed	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	No change over time or between groups' ratings of nausea.
Read 1991	Y/N	patient report (medical notes for 2 of Fluid group)	(g)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	No difference. Missing responses from 8 in Standard Fast group and 9 in Water group.
Fluids up to 180 mins preoperatively (+ H2‐Receptor Antagonist)
Gilbert 1995	VAS	patient completed	(g 2hrs)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water + Ranitidine [150mg] (500 ‐1000ml) (n = 46)	No difference. Low scores.

Table 23. Shortened Fluid Fast v Standard Fast ‐ Nausea

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Table 24. Shortened Fluid Fast v Standard Fast ‐ Vomiting

Trial	Method	Measure	Time of Measure	Comparison	Result
Fluids up to 90 mins preoperatively
Søreide 1993a	Y/N	Patient report	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Participants asked re incidence of vomiting but no report = no vomiting?
Søreide 1993b	Y/N	Patient report	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	Participants asked re incidence of vomiting but no report = no vomiting?
Fluids 120‐180 mins preoperatively
Agarwal 1989	noted	Unclear	(e ‐ f) post premedication	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	None observed
Read 1991	Y/N	Patient report (and medical notes for 2 from fluid group)	(g)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	No difference between groups. (8 Standard Fast and 9 Water group missing vomiting data).
Fluids up to 180 mins preoperatively (+ H2‐Receptor Antagonist)
Gilbert 1995	VAS	Patient rating	(g) 2hrs post op	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water + Ranitidine [150mg] (500 ‐1000ml) (n = 46)	No difference between groups. Low scores.

Table 24. Shortened Fluid Fast v Standard Fast ‐ Vomiting

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Table 25. Shortened Fluid Fast v Standard Fast ‐ Anxiety

Trial	Method	Measure	Time of Measure	Comparison	Result
Fluids up to 90 mins preoperatively
Søreide 1993a	VAS	Anxiety	(b) (f)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Water group < anxiety between (b) and (f).
Søreide 1993b	VAS	Anxiety	(b) (f)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No difference over time between Standard Fast and Water groups.
Fluids 120‐180 mins preoperatively
Hausel 2001a	VAS	Anxiety	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	No change over time in the groups' ratings of anxiety.
Hausel 2001b	VAS	Anxiety	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	No change over time in the Standard Fast group's report of anxiety while the Carbohydrate group recorded decreased anxiety over time. After the intake of the intervention the carbohydrate group rated significantly lower anxiety scores than the Standard Fast group.
Read 1991	VAS	1. dry mouth (anxiety)2. Nervousness (anxiety)	1. at (b) and (f)2. at (f)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	1. at (b) and (f) Water = Standard Fast group 2. Water < than Standard Fast group ( p = 0.03)
Fluids up to 180 mins preoperatively (+H2‐Receptor Antagonist)
Gilbert 1995	BSW	Well being compared to 1. pre‐admission2. previous anaesthetic(s)	(g) (2 hrs)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water + Ranitidine [150mg] (500 ‐1000ml) (n = 46)	1. Water = Standard Fast group 2. Water > felt better than Standard Fast group (p = 0.04)

Table 25. Shortened Fluid Fast v Standard Fast ‐ Anxiety

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Table 26. Type of Intake ‐ Secondary Outcome Measures

Fasting Regimen	Thirst	Hunger	Pain	Nausea	Vomiting	Anxiety
Water v Standard Fast
Agarwal 1989	NSMS	NSMS	_	noted	noted	_
Gilbert 1995	VAS	VAS	_	VAS	VAS	BSW
Hausel 2001a	VAS	VAS	VAS	VAS	_	VAS
Maltby 1986a/b	NMME	NMME	_	_	_	_
Read 1991	VAS (x4)	_	_	Y/N	Y/N	VAS
Soreide 1993a/b	VAS	_	VAS	reported	reported	VAS
Yatsu 1996a	VAS	VAS	_	_	_	_
Coffee v Standard Fast
Hutchinson 1988a+c	NSMS	NSMS	_	_	_	_
Juice v Standard Fast						_
Hutchinson 1988b + d	NSMS	NSMS	_	_	_	_
Vincent 1991	_	_	_	_	noted
Other Fluids v Standard Fast
Goodwin 1991	VAS	VAS	VAS	VAS	VAS	_
Hausel 2001c	VAS	VAS	VAS	VAS	_	VAS
Phillips 1993	NMMS	NMMS	_	_	_	_
Splinter 1991	VAS	VAS	_	_	_	_
Yatsu 1996 b	VAS	VAS	_	_	_	_
Assam tea v apple juice
Tanabe 1996	VAS	VAS	_	_	_	_
Carbohydrate drink v placebo (water)
Hausel 2001c	VAS	VAS	VAS	VAS	_	VAS
Isotonic Drink v Water
Yatsu 1996 c	VAS	VAS	_	_	_	_
Coffee v orange juice
Hutchinson 1988e/f	NSMS	NSMS	_	_	_	_
Fluid v fluid + food
Tanabe 1997	1‐4	1‐4	_	_	_	_

Table 26. Type of Intake ‐ Secondary Outcome Measures

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Table 27. Type of Fluid v Standard Fast ‐ Thirst

Trial	Measure	Time of Measurment	Comparison	Result
Water v Standard Fast
Agarwal 1989	NSMS	(d), (f)	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	Water group had more decreased thirst ratings than Fast group (p < 0.05). More Fast group recorded increased levels of thirst than Water group (p < 0.05)
Gilbert 1995	VAS	(g)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46)	Water group reported lower thirst scores than Fast group (p= 0.015).
Hausel 2001a	VAS	(a), (d), (e x2) (80 and 30 mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	Standard Fast group increased thirst over time. Water group had no significant change in thirst levels over time but were significantly less thristy than Standard Fast group.
Maltby 1986a	NMME	(b), (f)	1. Standard Fast + Placebo (n = 35) 2. Water [150 ml] + Placebo (n = 35)	Water group at (f) recorded lower thirst scores than at (b). No other reported differences
Maltby 1986b	NMME	(b), (f)	1. Standard Fast + Ranitidine [150mg] (n = 35) 2. Water [150 ml] + Ranitidine [150mg] (n = 35)	Water group at (f) recorded lower thirst scores than at (b). No other reported differences
Read 1991	VAS (x4)	(c)1. Normal degree of 'thirstiness';2. Usual dryness of mouth;(e)3. Current dryness of mouth.(g ‐1 day)4. Satisfaction with fluid management	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	1. No difference between groups.2. No difference between groups.3. No difference between groups.4. No difference between groups.
Søreide 1993a	VAS x 2Thirst Dry mouth	(b), (f), (g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Both groups recorded decreased thirst and dryness of mouth between (b) and (f). Reduction tended to be greater in Water group than Fast (p = 0.08). At (g) no differences between groups.
Søreide 1993b	VAS x 2Thirst Dry mouth	(b), (f), (g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	Both groups recorded decreased thirst and dryness of mouth between (b) and (f). Reduction tended to be greater in Water group than Standard Fast (p = 0.08). At (g) no differences between groups.
Yatsu 1996a	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Water [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups
Coffee v Standard Fast
Hutchinson 1988a	NSMS	(c), (f)	1. Standard Fast + placebo (n = 50) 2. Coffee [150mls] (milk permitted) + placebo (n = 50)	More Coffee group reduced thirst scores over time (c‐f) than the Standard Fast group (p< 0.001). More Standard Fast group recorded greater thirst scores over time (c‐f) than the Coffee group (p< 0.001).
Hutchinson 1988c	NSMS	(c), (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Coffee [150mls] (milk permitted) + Ranitidine [150mg] (n = 50)	More Coffee group had reduced thirst scores at (f) from scores at (c) than the Standard Fast group. More of the Standard Fast group increased their thirst scores overtime than the Coffee group.
Orange Juice v Fast
Hutchinson 1988b	NSMS	(c), (f)	1. Standard Fast + Ranitidine [150mg] (n = 35) 2. Water [150 ml] + Ranitidine [150mg] (n = 35)	More Orange Juice group reduced thirst ratings over time (c‐f) than the Standard Fast group (p< 0.001). More control group recorded greater thirst scores over time (c‐f) than the intervention group (p< 0.001).
Hutchinson 1988d	NSMS	(c), (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Orange Juice [150mls] + Ranitidine [150mg] (n = 50)	More Orange Juice group had reduced thirst scores at (f) from scores at (c) than the Standard Fast group. More of the Standard Fast group increased their thirst scores overtime than the Orange Juice group.
Other Fluids v Standard Fast
Goodwin 1991	LAS	(c), (f)	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	Water/Orange group recorded reduced and the Standard Fast group increased thirst scores at (f) compared to (c) (p = <0.001). The Water/Orange group's thirst scores at (f) significantly lower than scores of Fast group (p < 0.001).
Hausel 2001b	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86)2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	The Standard Fast group rated their thirst as increasing over the preoperative period while the Carbohydrate group reported decreasing thirst scores. At the three time points (d) and (e x 2) the Carbohydrate group rated their thirst as significantly less than the thirst ratings made by the Standard Fast group.
Phillips 1993	NMMS	(f)	1. Standard Fast (n = 50) 2. Clear Fluids [unlimited] (n = 50)	Clear Fluids group rated thirst as less severe than Standard Fast group (p < 0.001).
Splinter 1991	VAS	(f)	1. Standard Fast (n = 76) 2. Clear Fluids [unlimited] (n = 76)	Clear Fluids group recorded lower thrist scores than the Standard Fast group (p < 0.05).
Yatsu 1996a	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Water [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups

Table 27. Type of Fluid v Standard Fast ‐ Thirst

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Table 28. Type of Fluid v Standard Fast ‐ Hunger

Trial	Measure	Time of Measurement	Comparison	Result
Water v Standard Fast
Agarwal 1989	NSMS	(c) (f)	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	Water group had more decreased hunger ratings over time than Standard Fast group (p < 0.05).
Gilbert 1995	VAS	(g)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46)	No difference between groups' hunger ratings (p = 0.90).
Hausel 2001a	VAS	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	Standard Fast group increased hunger scores over preoperative time. Water group hunger ratings unchanged over time. No difference between groups' hunger ratings.
Maltby 1986a	NMME	(b) (f)	1. Standard Fast + Placebo (n = 35) 2. Water [150 ml] + Placebo (n = 35)	No difference in hunger ratings within groups overtime.
Maltby 1986b	NMME	(b) (f)	1. Standard Fast + Ranitidine [150mg] (n = 35) 2. Water [150 ml] + Ranitidine [150mg] (n = 35)	No difference in hunger ratings within groups overtime.
Yatsu 1996a	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Water [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups
Coffee v Standard Fast
Hutchinson 1988a	NSMS	(c) (f)	1. Standard Fast + placebo (n = 50) 2. Coffee [150mls] (milk permitted) + placebo (n = 50)	Coffee group had more decreased hunger ratings over time the Standard Fast group (p < 0.001).
Hutchinson 1988c	NSMS	(c) (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Coffee [150mls] (milk permitted) + Ranitidine [150mg] (n = 50)	No difference between groups.
Orange Juice v Standard Fast
Hutchinson 1988b	NSMS	(c) (f)	1. Standard Fast + placebo [150mg] (n = 35) 2. Orange Juice [150 ml] + placebo [150mg] (n = 35)	Orange Juice group had more decreased hunger ratings over time the Standard Fast group (p < 0.001).
Hutchinson 1988d	NSMS	(c) (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Orange Juice [150mls] + Ranitidine [150mg] (n = 50)	No difference between groups.
Other Fluids
Goodwin 1991	LAS	(c) (f)	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	No difference between groups. Increase in preoperative hunger within both groups (p< 0.01).
Hausel 2001b	VAS	(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86)2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	Standard Fast group scored higher hunger scores over preoperative time while the Carbohydrate group scored lower hunger scores overtime. At time points (d) and (ex2 ) the Carbohydrate group's hunger ratings were lower than the Standard Fast group's.
Phillips 1993	NMMS	(f)	1. Standard Fast (n = 50) 2. Clear Fluids [unlimited] (n = 50)	No difference between groups (p = 0.09).
Splinter 1991	VAS	(f)	1. Standard Fast (n = 76) 2. Clear Fluids [unlimited] (n = 76)	No difference between groups.
Yatsu 1996b	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Water [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups

Table 28. Type of Fluid v Standard Fast ‐ Hunger

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Table 29. Type of Fluid v Standard Fast ‐ Pain

Trial	Measure	Method	Time of Measure	Comparison	Result
Water v Standard Fast
Hausel 2001a	Pain	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening b4 and 400ml 2hrs preop (n = 86)	No differences.
Søreide 1993 a	Sore Throat	VAS	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	No differences.
Søreide 1993 b	Sore Throat	VAS	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No differences.
Other Fluids v Standard Fast
Goodwin 1991	Pain	VAS	(g)(x6) 30, 60, 120mins; on arrival at home; 12hrs; 24hrs post op.	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	Low scores. No difference except at 60 mins post surgery Standard Fast reported less pain than Water/Orange group (p < 0.05).
Hausel 2001b	Pain	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	No differences.

Table 29. Type of Fluid v Standard Fast ‐ Pain

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Table 30. Type of Fluid v Standard Fast ‐ Nausea

Trial	Method	Assessor	Time of Measure	Comparison	Result
Water v Standard Fast
Agarwal 1989	Noted	unclear	(e ‐ f) post premedication	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	None observed
Hausel 2001a	VAS	patient completed	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	No difference over time in the Standard Fast group's ratings of nausea but increased ratings of nausea over time by the Water group.
Gilbert 1995	VAS	patient completed	(g 2hrs)	1. Standard Fast + Ranitidine [150mg] (‐ 1 IV fluids) (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46)	No difference. Low scores.
Søreide 1993a	Y/N	patient report	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	No difference. Standard Fast = 1 patient reported nausea. Fluid = 2 patients reported nausea.
Søreide 1993b	Y/N	patient report	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No difference. Standard Fast = 1 patient reporte nausea. Fluid = 1 patient reported nausea.
Read 1991	Y/N	patient report (medical notes for 2 of Fluid group)	(g)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	No difference. Missing responses from 8 in Standard Fast group and 9 in Water group.
Other Fluids v Standard Fast
Goodwin 1991	VAS	patient completed	(gx6)30; 60; 120 mins; on arrival at home; 12hrs; 24 hrs.	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	No difference. Low scores.
Hausel 2001b	VAS	patient completed	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 86)	No change over time or between groups' ratings of nausea.

Table 30. Type of Fluid v Standard Fast ‐ Nausea

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Table 31. Type of Fluid v Standard Fast ‐ Vomiting

Trial	Method	Measurement	Time of Measure	Comparison	Result
Water v Standard Fast
Agarwal 1989	noted	Unclear	(e ‐ f) post premedication	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	None observed
Gilbert 1995	VAS	Patient rating	(g 2hrs)	1. Standard Fast + Ranitidine [150mg] (‐ 1 IV fluids) (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46) (‐ 1 < 200ml water) (‐ 3 IV fluids)	No difference between groups. Low scores.
Søreide 1993a	Y/N	Patient report	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Participants asked re incidence of vomiting but no report = no vomiting?
Søreide 1993b	Y/N	Patient report	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	Participants asked re incidence of vomiting but no report = no vomiting?
Read 1991	Y/N	Patient report (and medical notes for 2 from fluid group)	(g)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	No difference between groups. (Data missing from 8 Standard Fast group and 9 Water group).

Table 31. Type of Fluid v Standard Fast ‐ Vomiting

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Table 32. Type of Fluid v Standard Fast ‐ Anxiety

Trial	Method	Measure	Time of Measure	Comparison	Result
Water v Standard Fast
Gilbert 1995	BSW	Well being compared to 1. pre‐admission 2. previous anaesthetic(s)	(g) (2 hrs)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46)	1. Water = Standard Fast group 2. Water > felt better than Standard Fast group (p = 0.04)
Søreide 1993a	VAS	Anxiety	(b) (f)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Water group less Anxiety between (b) and (f).
Søreide 1993b	VAS	Anxiety	(b) (f)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No difference over time between Standard Fast and Water groups.
Hausel 2001a	VAS	Anxiety	(a), (d), (e x2) (80 and 30mins preop) (a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening b4 and 400ml 2hrs preop (n = 86)	No change over time in the groups' ratings of anxiety.
Read 1991	VAS	1. dry mouth (anxiety)2. Nervousness (anxiety)	1. at (b) and (f)2. at (f)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	1. at (b) and (f) Water = Standard Fast group 2. Water < than Standard Fast group ( p = 0.03)
Other Fluids v Standard Fast
Hausel 2001b	VAS	Anxiety	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Water [150mls] + Roxatidine [ 75mg x 2] (n = 15)	No change over time in the Standard Fast group's report of anxiety while the Carbohydrate group recorded decreased anxiety over time. After the intake of the intervention the carbohydrate group rated significantly lower anxiety scores than the Standard Fast group.

Table 32. Type of Fluid v Standard Fast ‐ Anxiety

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Table 33. Fluid 1 [F1] v Fluid 2 [F2] ‐ Thirst

Trial	Method	Time of Measure	Comparison	Results
Orange Juice [F1] v Coffee [milk permitted] [F2]
Hutchinson 1988e	NSMS	(c), (f)	1. Orange Juice + Placebo (n = 50) 2. Coffee [milk permitted] + Placebo (n = 50)	No difference between groups. No difference over time.
Hutchinson 1988f	NSMS	(c), (f)	1. Orange Juice + Ranitidine [150mg] (n = 50) 2. Coffee [milk permitted] + Ranitidine [150mg] (n = 50)	No difference between the groups. No difference over time.
Apple Juice [F1] v Assam Tea [F2]
Tanabe 1996	VAS	(f)	1. Apple juice + Roxatidine [75mg] + Famotidine [20mg] (n = 20) 2. Tea [no milk] + Roxatidine [75mg] + Famotidine [20mg] (n = 20)	No difference between groups.
Water [F1] v Isotonic Drink [F2]
Yatsu 1996c	VAS	(f)	1. Water [150mls] + Roxatidine [75mg x 2] (n = 15) 2. Isotonic Drink [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups
Water [F1] v Carbohydrate Drink [F2]
Hausel 2001c	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Water (n = 86) 2. Carbohydrate drink (n = 86)	Water group showed no difference in thrist over time but the Carbohydrate group rated their thirst as significantly less over time. The Carbohydrate group also were significantly less thirsty at time point (d) than the Water group.

Table 33. Fluid 1 [F1] v Fluid 2 [F2] ‐ Thirst

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Table 34. Fluid 1 [F1] v Fluid 2 [F2] ‐ Hunger

Trial	Method	Measure	Comparison	Result
Orange Juice [F1] v Coffee (milk permitted) [F2]
Hutchinson 1988e	NSMS	(c) (f)	1. Orange Juice + Placebo (n = 50) 2. Coffee [milk permitted] + Placebo (n = 50)	No difference between groups
Hutchinson 1988f	NSMS	(c) (f)	1. Orange Juice + Ranitidine [150mg] (n = 50) 2. Coffee [milk permitted] + Ranitidine [150mg] (n = 50)	No difference between groups
Apple Juice [F1] v Assam Tea [F2]
Tanabe 1996	VAS	(f)	1. Apple juice + Roxatidine [75mg] + Famotidine [20mg] (n = 20) 2. Tea [no milk] + Roxatidine [75mg] + Famotidine [20mg] (n = 20)	No difference between groups.
Water [F1] v Carbohydrate Drink [F2]
Hausel 2001c	VAS	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Water (n = 86) 2. Carbohydrate drink (n = 86)	Water group showed no difference in hunger over time but the Carbohydrate group recorded lower hunger scores over time. The Carbohydrate group also was significantly less hungry at time points (d) and (e x 2) than the Water group.
Water [F1] v Isotonic Drink [F2]
Yatsu 1996c	VAS	(f)	1. Water [150mls] + Roxatidine [75mg x 2] (n = 15) 2. Isotonic Drink [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups

Table 34. Fluid 1 [F1] v Fluid 2 [F2] ‐ Hunger

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Table 35. Fluid 1 [F1] v Fluid 2 [F2] ‐ Nausea

Trial	Method	Assessor	Time of Measure	Comparison	Result
Water v Carbohydrate Drink
Hausel 2001c	patient completed VAS	VAS	(a), (d), (e x2) (80 and 30 mins preop)	1. Water (n = 86) 2. Carbohydrate drink (n = 86)	The Water group reported increasing nausea over preoperative time. There was no between group difference in nausea scores.

Table 35. Fluid 1 [F1] v Fluid 2 [F2] ‐ Nausea

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Table 36. Fluid 1 [F1] v Fluid 2 [F2] ‐ Anxiety

Trial	Method	Assessor	Time of Measure	Comparison	Result
Water v Carbohydrate Drink
Hausel 2001c	patient completed VAS	VAS	(a), (d), (e x2)(80 and 30mins preop)	1. Water (n = 86) 2. Carbohydrate drink (n = 86)	No change over time in anxiety over the preoperative period reported by group permitted water. After the intake of a carbohydrate drink the group rated significantly lower anxiety scores than the group that drank water (e x 2) and recorded decreased anxiety over the preoperative period (d to e x 2).

Table 36. Fluid 1 [F1] v Fluid 2 [F2] ‐ Anxiety

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Table 37. Volume of Intake ‐ Secondary Outcome Measures

Comparison	Thirst	Hunger	Pain	Nausea	Vomiting	Anxiety
Low Volume Fluid Intake v Standard Fast
Agarwal 1989	NSMS	NSMS	_	noted	noted	_
Goodwin 1991	VAS	VAS	VAS	VAS	noted	_
Hutchinson 1988 a/b/c/d	NSMS	NSMS	_	_	_	_
Maltby 1986a/b	NMME	NMME	_	_	_	_
Soreide 1993 a	VAS	_	VAS	reported	reported	VAS
Yatsu 1996 a/b	VAS	VAS	_	_	_	_
High Volume of Fluid Intake v Standard Fast
Gilbert 1995	VAS	VAS	_	VAS	VAS	BSW
Hausel 2001a/b	VAS	VAS	VAS	VAS	_	VAS
Soreide 1993 b	VAS	_	VAS	reported	reported	VAS
Vincent 1991	_	_	_	_	noted	_
Unlimited Fluids v Standard Fast
Phillips 1993	NMMS	NMMS	_	_	_	_
Read 1991	VAS (x4)	_	_	Y/N	Y/N	VAS
Splinter 1991	VAS	VAS	_	_	_	_
Low v High Volume Fluid Intake
Soreide 1993 c	VAS	_	VAS	reported	reported	VAS

Table 37. Volume of Intake ‐ Secondary Outcome Measures

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Table 38. Volume of Fluid v Standard Fast ‐ Thirst

Trial	Measure	Time of Measurement	Comparison	Result
Low Volume Fluid Intake v Standard Fast
Agarwal 1989	NSMS	(d), (f)	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	Low Volume (water) group had more decreased thirst ratings than Standard Fast group (p < 0.05). More Standard Fast group recorded increased levels of thirst than Low Volume (water) group (p < 0.05)
Goodwin 1991	LAS	(c), (f)	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	Low Volume group recorded reduced and the Standard Fast group increased thirst scores at (f) compared to (c) (p = <0.001). The Low Volume (Water/Orange) group's thirst scores at (f) significantly lower than scores of Fast group (p < 0.001).
Hutchinson 1988a	NSMS	(c), (f)	1. Standard Fast + Placebo (n = 50) 2. Coffee [150mls] (milk permitted) + Placebo (n = 50)	More Low Volume (coffee) group reduced thirst scores over time (c‐f) than the Standard Fast group (p< 0.001). More Standard Fast group recorded greater thirst scores over time (c‐f) than the Low Volume (coffee) group (p< 0.001).
Hutchinson 1988b	NSMS	(c), (f)	1. Standard Fast + Placebo (n = 50) 2. Orange Juice [150mls] + Placebo (n = 50)	More Low Volume (orange juice) group reduced thirst ratings over time (c‐f) than the Standard Fast group (p< 0.001). More control group recorded greater thirst scores over time (c‐f) than the intervention group (p< 0.001).
Hutchinson 1988c	NSMS	(c), (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Coffee [150mls] (milk permitted) + Ranitidine [150mg] (n = 50)	More Low Volume (coffee) group had reduced thirst scores at (f) from scores at (c) than the Standard Fast group. More of the Standard Fast group increased their thirst scores overtime than the Low Volume (coffee) group.
Hutchinson 1988d	NSMS	(c), (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Orange Juice [150mls] + Ranitidine [150mg] (n = 50)	More Low Volume (orange juice) group had reduced thirst scores at (f) from scores at (c) than the Standard Fast group. More of the Standard Fast group increased their thirst scores overtime than the Low Volume (orange juice) group.
Maltby 1986a	NMME	(b), (f)	1. Standard Fast + Placebo (n = 35) 2. Water [150 ml] + Placebo (n = 35)	Low Volume (water) group at (f) recorded lower thirst scores than at (b). No other reported differences
Maltby 1986b	NMME	(b), (f)	1. Standard Fast + Ranitidine [150mg] (n = 35) 2. Water [150 ml] + Ranitidine [150mg] (n = 35)	Low Volume (water) group at (f) recorded lower thirst scores than at (b). No other reported differences
Søreide 1993a	VAS x 2Thirst Dry mouth	(b), (f), (g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Both groups recorded decreased thirst and dryness of mouth between (b) and (f). Reduction tended to be greater in Low Volume (water) group than Standard Fast (p = 0.08). At (g) no differences between groups.
Yatsu 1996a	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Water [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups
Yatsu 1996b	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Isotonic Drink [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups
High Volume Fluid Intake v Standard Fast
Gilbert 1995	VAS	(g)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46)	High Volume (water) group reported lower thirst scores than Standard Fast group (p= 0.015). Median and CI available.
Hausel 2001a	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	Standard Fast group increased thirst over time. High Volume (water) group had no significant change in thirst levels over time but were significantly less thristy than Standard Fast group.
Hausel 2001b	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 80)	The Standard Fast group rated their thirst as increasing over the preoperative period while the High Volume (carbohydrate drink) group reported decreasing thirst scores. At the three time points (d) and (e x 2) the High Volume (carbohydrate drink) group rated their thirst as significantly less than the thirst ratings made by the Standard Fast group.
Søreide 1993b	VAS x 2Thirst Dry mouth	(b), (f), (g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	Both groups recorded decreased thirst and dryness of mouth between (b) and (f). Reduction tended to be greater in the High Volume (water) group than Standard Fast (p = 0.08). At (g) no differences between groups.
Unlimited Fluid Intake v Standard Fast
Phillips 1993	NMMS	(f)	1. Standard Fast (n = 50) 2. Clear Fluids [unlimited] (n = 50)	Unlimited Volume (clear fluids) group rated thirst as less severe than Standard Fast group (p < 0.001).
Read 1991	VAS (x4)	(c)1. Normal degree of 'thirstiness';2. Usual dryness of mouth;(e)3. Current dryness of mouth.(g ‐1 day)4. Satisfaction with fluid management	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	1. No difference between groups.2. No difference between groups.3. No difference between groups.4. No difference between groups.
Splinter 1991	VAS	(f)	1. Standard Fast (n = 76) 2. Clear Fluids [unlimited] (n = 76)	Unlimited Volume (clear fluids) group recorded lower thrist scores than the Standard Fast group (p < 0.05).

Table 38. Volume of Fluid v Standard Fast ‐ Thirst

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Table 39. Volume of Fluid v Standard Fast ‐ Hunger

Trial	Measure	Time of Measurement	Comparison	Result
Low Volume Fluid Intake v Standard Fast
Agarwal 1989	NSMS	(c) (f)	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	Low Volume (water) group had more decreased hunger ratings over time than Standard Fast group (p < 0.05).
Goodwin 1991	LAS	(c) (f)	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	No difference between groups. Increase in preoperative hunger within both groups (p< 0.01).
Hutchinson 1988a	NSMS	(c) (f)	1. Standard Fast + Placebo (n = 50) 2. Coffee [150mls] (milk permitted) + Placebo (n = 50)	Low Volume (coffee) group had more decreased hunger ratings over time the Standard Fast group (p < 0.001).
Hutchinson 1988b	NSMS	(c) (f)	1. Standard Fast+ Placebo (n = 50) 2. Orange Juice [150mls] + Placebo (n = 50)	Low Volume (orange juice) group had more decreased hunger ratings over time the Standard Fast group (p < 0.001).
Hutchinson 1988c	NSMS	(c) (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Coffee [150mls] (milk permitted) + Ranitidine [150mg] (n = 50)	No difference between groups.
Hutchinson 1988d	NSMS	(c) (f)	1. Standard Fast + Ranitidine [150mg] (n = 50) 2. Orange Juice [150mls] + Ranitidine [150mg] (n = 50)	No difference between groups.
Maltby 1986a	NMME	(b) (f)	1. Standard Fast + Placebo (n = 35) 2. Water [150 ml] + Placebo (n = 35)	No difference in hunger ratings within groups overtime.
Maltby 1986b	NMME	(b) (f)	1. Standard Fast + Ranitidine [150mg] (n = 35) 2. Water [150 ml] + Ranitidine [150mg] (n = 35)	No difference in hunger ratings within groups overtime.
Yatsu 1996a	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Water [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups
Yatsu 1996b	VAS	(f)	1. Standard Fast + Roxatidine [75mg x 2] (n = 15) 2. Isotonic Drink [150mls] + Roxatidine [75mg x 2] (n = 15)	No difference between groups
High Volume of Intake v Standard Fast
Gilbert 1995	VAS	(g)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46)	No difference between groups' hunger ratings (p = 0.90).
Hausel 2001a	VAS	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before surgery and 400ml 2hrs preop (n = 86)	Standard Fast group increased hunger scores over preoperative time. High Volume (water) group hunger ratings unchanged over time. No difference between groups' hunger ratings.
Hausel 2001b	VAS	(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 80)	Standard Fast group scored higher hunger scores over preoperative time while the High Volume (carbohydrate drink) group scored lower hunger scores overtime. At time points (d) and (ex2 ) the High Volume (carbohydrate drink) group's hunger ratings were lower than the Fast group's.
Unlimited Fluid Intake v Standard Fast
Phillips 1993	NMMS	(f)	1. Standard Fast (n = 50) 2. Clear Fluid [unlimited] (n = 50)	No difference between groups (p = 0.09).
Splinter 1991	VAS	(f)	1. Standard Fast (n = 76) 2. Clear Fluids [unlimited] (n = 76)	No difference between groups.

Table 39. Volume of Fluid v Standard Fast ‐ Hunger

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Table 40. Volume of Fluid v Standard Fast ‐ Pain

Trial	Measure	Method	Time of Measurement	Comparison	Result
Low Volume v Standard Fast
Goodwin 1991	Pain	VAS	(g)(x6) 30, 60, 120mins; on arrival at home; 12hrs; 24hrs post op.	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	Low scores. No difference except at 60 mins post surgery Standard Fast group reported less pain than Low Volume (water/orange) group (p < 0.05).
Søreide 1993a	Sore Throat	VAS	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	No differences.
High Volume v Standard Fast
Hausel 2001a	Pain	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	No differences.
Hausel 2001b	Pain	VAS	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 80)	No differences.
Søreide 1993b	Sore Throat	VAS	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No differences.

Table 40. Volume of Fluid v Standard Fast ‐ Pain

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Table 41. Volume of Fluid v Standard Fast ‐ Nausea

Trial	Method	Assessor	Time of Measurement	Comparison	Result
Low Volume of Fluid Intake v Standard Fast
Agarwal 1989	Noted	unclear	(e ‐ f) post premedication	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	None observed
Goodwin 1991	VAS	patient completed	(gx6)30; 60; 120 mins; on arrival at home; 12hrs; 24 hrs.	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	No difference. Low scores.
Søreide 1993a	Y/N	patient report	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	No difference. Standard Fast = 1 patient reported nausea. Low Volume (water) group = 2 patients reported nausea.
High Volume v Stanard Fast
Gilbert 1995	VAS	patient completed	(g 2hrs)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46)	No difference. Low scores.
Hausel 2001a	VAS	patient completed	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening b4 and 400ml 2hrs preop (n = 86)	No difference over time in the Standard Fast group's ratings of nausea but increased ratings of nausea over time by the High Volume (water) group.
Hausel 2001b	VAS	patient completed	(a), (d), (e x2) (80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 80)	No change over time or between groups' ratings of nausea.
Søreide 1993b	Y/N	patient report	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No difference. Standard Fast = 1 patient reported nausea. High Volume (water) group = 1 patient reported nausea.
Unlimited Fluids v Standard Fast
Read 1991	Y/N	patient report (medical notes for 2 of Fluid group)	(g)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	No difference. Missing responses from 8 in Standard Fast group and 9 in Unlimited Volume (water) group.

Table 41. Volume of Fluid v Standard Fast ‐ Nausea

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Table 42. Volume of Fluid v Standard Fast ‐ Vomiting

Trial	Method	Measure	Time of Measure	Comparison	Result
Low Volume Fluid Intake v Standard Fast
Agarwal 1989	noted	Unclear	(e ‐ f) post premedication	1. Standard Fast (n = 50) 2. Water [150mls] (n = 50)	None observed
Goodwin	noted	Unclear	during anaesthesia	1. Standard Fast (n = 49) 2. Water/Orange drink [150mls] (n = 50)	None observed
Søreide 1993a	Y/N	Patient report	(g)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Participants asked re incidence of vomiting but no report = no vomiting?
High Volume Fluid Intake v Standard Fast
Gilbert 1995	VAS	Patient rating	(g 2hrs)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46) (‐ 1 < 200ml water) (‐ 3 IV fluids)	No difference between groups. Low scores.
Søreide 1993b	Y/N	Patient report	(g)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	Participants asked re incidence of vomiting but no report = no vomiting?
Unlimited Fluid Intake v Standard Fast
Read 1991	Y/N	Patient report (and medical notes for 2 from fluid group)	(g)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	No difference between groups. (8 Standard Fast and 9 Unlimited Volume (water) missing data).
Vincent

Table 42. Volume of Fluid v Standard Fast ‐ Vomiting

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Table 43. Volume of Fluid v Standard Fast ‐ Anxiety

Trial	Method	Measure	Time of Measurement	Comparison	Result
Low Volume of Fluid Intake v Standard Fast
Søreide 1993a	VAS	Anxiety	(b) (f)	1. Standard Fast (n = 25) 2. Water [150mls] (n = 25)	Low Volume (water) group < anxiety between (b) and (f).
High Volume of Fluid Intake v Standard Fast
Gilbert 1995	BSW	Well being compared to 1. pre‐admission2. previous anaesthetic(s)	(g) (2 hrs)	1. Standard Fast + Ranitidine [150mg] (n = 49) 2. Water (500 ‐1000ml) + Ranitidine [150mg] (n = 46)	1. High Volume (water) group = Standard Fast group 2.High Volume (water) group > felt better than Standard Fast group (p = 0.04)
Hausel 2001a	VAS	Anxiety	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Water 800ml evening before and 400ml 2hrs preop (n = 86)	No change over time in the groups' ratings of anxiety.
Hausel 2001b	VAS	Anxiety	(a), (d), (e x2)(80 and 30mins preop)(a), (d), (e x2)(80 and 30mins preop)	1. Standard Fast (n = 86) 2. Carbohydrate drink [800ml evening before surgery and 400ml 2hrs preop] (n = 80)	No change over time in the Standard Fast group's report of anxiety while the High Volume (carbohydrate drink) group recorded decreased anxiety over time. After the intake of the intervention the High Volume (carbohydrate drink) group rated significantly lower anxiety scores than the Standard Fast group.
Søreide 1993b	VAS	Anxiety	(b) (f)	1. Standard Fast (n = 25) 2. Water [300‐450mls] (n = 25)	No difference over time between Standard Fast and High Volume (water) groups.
Unlimited Fluid Intake v Standard Fast
Read 1991	VAS	1. dry mouth (anxiety)2. Nervousness (anxiety)	1. at (b) and (f)2. at (f)	1. Standard Fast (n = 29) 2. Water [unlimited] (n = 25)	1. at (b) and (f) Unlimited Volume (water) group = Standard Fast group 2. Unlimited Volume (water) group < than Standard Fast group ( p = 0.03)

Table 43. Volume of Fluid v Standard Fast ‐ Anxiety

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Table 44. Volume 1 [V1] v Volume 2 [V2] ‐ Thirst

Trial	Method	Measure	Comparison	Result
Low v High Volume Fluid Intake
Søreide 1993c	VAS x 2Thirst Dry mouth	(b), (f), (g)	1. 150mls [water] (n = 25) 2. 300‐450mls [water] (n = 25)	Both groups recorded decreased thirst and dryness of mouth between (b) and (f). At (g) no differences between groups.

Table 44. Volume 1 [V1] v Volume 2 [V2] ‐ Thirst

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Table 45. Volume 1 [V1] v Volume 2 [V2] ‐ Pain

Trial	Measure	Method	Time of Measure	Comparison	Result
Low V High Volume Fluid Intake
Søreide 1993c	Sore throat	VAS	(g)	1. 150mls [water] (n = 25) 2. 300‐450mls [water] (n = 25)	No differences.

Table 45. Volume 1 [V1] v Volume 2 [V2] ‐ Pain

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Table 46. Volume 1 [V1] v Volume 2 [V2] ‐ Nausea

Trial	Method	Measure	Time of Measure	Comparison	Result
Low v High Volume Fluid Intake
Søreide 1993c.	Y/N	patient report	(g)	1. 150mls [water] (n = 25) 2. 300‐450mls [water] (n = 25)	No difference. Low Volume (150ml water) group = 2 patients reported nausea. High Volume (300‐450ml water) group = 1 patient reported nausea.

Table 46. Volume 1 [V1] v Volume 2 [V2] ‐ Nausea

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Table 47. Volume 1 [V1] v Volume 2 [V2] ‐ Vomiting

Trial	Method	Assessor	Time of Measure	Comparison	Result
Low v High Volume Fluid Intake
Søreide 1993c	Y/N	Patient report	(g)	1. 150mls [water] (n = 25) 2. 300‐450mls [water] (n = 25)	Participants asked re incidence of vomiting. Result not reported = no vomiting?

Table 47. Volume 1 [V1] v Volume 2 [V2] ‐ Vomiting

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Table 48. Volume 1 [V1] v Volume 2 [V2] ‐ Anxiety

Trial	Method	Measure	Time of Measure	Comparison	Result
Low v High Volume Fluid Intake
Søreide 1993c.	VAS	Anxiety	(b) (f)	1. 150mls [water] (n = 25) 2. 300‐450mls [water] (n = 25)	Low Volume (150mls water) group decreased anxiety ratings between (b) and (f). No other differences of note.

Table 48. Volume 1 [V1] v Volume 2 [V2] ‐ Anxiety

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Table 49. 'At Risk' Patient Populations ‐ Thirst

Trial	Patient Population	Measure	Time of Measurement	Comparison	Result
Lam 1993	Women 5 days postpartum	NSS	(f)	1. Standard Fast (n = 50)2. Water [150mls] (n = 50)	Water group reported less thirst than the standard fast group.

Table 49. 'At Risk' Patient Populations ‐ Thirst

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Comparison 1. Duration ‐ Shortened Fluid Fast v Standard Fast

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gastric Contents ‐ Volume (ml) Show forest plot	24		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Fluids (up to 90 mins preop) v Standard Fast	2	75	Mean Difference (IV, Random, 95% CI)	‐8.0 [‐25.53, 9.53]
1.2 Fluids (120 ‐180 mins preop) v Standard Fast	20	1332	Mean Difference (IV, Random, 95% CI)	‐0.84 [‐2.77, 1.08]
1.3 Fluids (120‐180 minutes preop) v Standard Fast (no H2‐receptor antagonists)	12	921	Mean Difference (IV, Random, 95% CI)	‐2.05 [‐5.59, 1.48]
1.4 Fluids (120‐180 minutes preop) v Standard Fast (+ H2‐receptor antagonists)	8	411	Mean Difference (IV, Random, 95% CI)	‐0.19 [‐1.98, 1.60]
1.5 Fluids (up to 180 mins preop) v Standard Fast ( no H2‐receptor antagonist)	1	152	Mean Difference (IV, Random, 95% CI)	‐3.04 [‐10.34, 4.26]
1.6 Fluids (up to 180 mins preop) v Standard Fast (+ H2 Receptor antagonist)	1	53	Mean Difference (IV, Random, 95% CI)	3.0 [‐4.07, 10.07]
2 Gastric Contents ‐ pH Show forest plot	24		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Fluids (up to 90 mins preop) v Standard Fast	2	75	Mean Difference (IV, Random, 95% CI)	‐0.19 [‐0.78, 0.40]
2.2 Fluids (120‐180 mins preop) v Standard Fast	20	1132	Mean Difference (IV, Random, 95% CI)	0.14 [‐0.04, 0.31]
2.3 Fluids (120‐180 mins preop) v Standard Fast (no H2‐receptor antagonists)	12	773	Mean Difference (IV, Random, 95% CI)	0.16 [‐0.04, 0.35]
2.4 Fluids (120‐180 mins preop) v Standard Fast (+ H2‐receptor antagonists)	8	359	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.43, 0.47]
2.5 Fluids Permitted (up to 180 mins preop) v Standard Fast (no H2‐receptor antagonists)	1	152	Mean Difference (IV, Random, 95% CI)	0.20 [‐0.04, 0.44]
2.6 Fluids Permitted (up to 180 mins preop) v Standard Fast (+ H2‐receptor antagonist)	1	33	Mean Difference (IV, Random, 95% CI)	‐0.62 [‐2.21, 0.97]
3 Gastric Contents ‐ Cyanoconolamin (ml) Show forest plot	2	142	Mean Difference (IV, Fixed, 95% CI)	‐3.50 [‐14.24, 7.24]

3.1 Fluids (120‐180 minutes preop) v Standard Fast	2	142	Mean Difference (IV, Fixed, 95% CI)	‐3.50 [‐14.24, 7.24]
4 Gastric Contents ‐ BSP (%) Show forest plot	4		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 Fluids (120‐180 minutes preop) v Standard Fast	4	240	Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.27, 0.10]
4.2 Fluids (120‐180 minutes preop) v Standard Fast (no H2‐receptor antagonist)	2	120	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4.3 Fluids (120‐180 minutes preop) v Standard Fast (+ H2‐receptor antagonist)	2	120	Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.27, 0.10]

Comparison 1. Duration ‐ Shortened Fluid Fast v Standard Fast

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Comparison 2. Duration ‐ Shortened Solid Fast v Standard Fast

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gastric Contents ‐ Volume (ml) Show forest plot	2	45	Mean Difference (IV, Fixed, 95% CI)	0.88 [‐7.68, 9.44]

1.1 Shortened Solid Fast v Standard Fast	2	45	Mean Difference (IV, Fixed, 95% CI)	0.88 [‐7.68, 9.44]
2 Gastric Contents ‐ pH Show forest plot	2	30	Mean Difference (IV, Random, 95% CI)	‐1.15 [‐4.09, 1.79]

2.1 Shortened Solid Fast v Standard Fast	2	30	Mean Difference (IV, Random, 95% CI)	‐1.15 [‐4.09, 1.79]

Comparison 2. Duration ‐ Shortened Solid Fast v Standard Fast

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Comparison 3. Duration ‐ Shortened Solid Fast v Shortened Fluid Fast

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gastric Contents ‐ Volume (ml) Show forest plot	1	40	Mean Difference (IV, Fixed, 95% CI)	‐1.70 [‐12.44, 9.04]

1.1 Shortened Solid Fast v Shortened Fluid Fast	1	40	Mean Difference (IV, Fixed, 95% CI)	‐1.70 [‐12.44, 9.04]
2 Gastric Contents ‐ pH Show forest plot	1	40	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐1.13, 1.73]

2.1 Shortened Solid Fast v Shortened Fluid Fast	1	40	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐1.13, 1.73]

Comparison 3. Duration ‐ Shortened Solid Fast v Shortened Fluid Fast

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Comparison 4. Type of Intake ‐ Fluid v Standard Fast

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gastric Contents ‐ Volume (ml) Show forest plot	24		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Water v Standard Fast	14	857	Mean Difference (IV, Random, 95% CI)	‐2.51 [‐4.60, ‐0.42]
1.2 Water v Standard Fast (no H2‐receptor antagonists)	9	611	Mean Difference (IV, Random, 95% CI)	‐6.16 [‐9.41, ‐2.91]
1.3 Water v Standard Fast (+ H2‐receptor antagonists)	5	246	Mean Difference (IV, Random, 95% CI)	‐0.71 [‐2.55, 1.13]
1.4 Coffee [+milk on request] v Standard Fast (no H2‐receptor antagonists)	1	100	Mean Difference (IV, Random, 95% CI)	1.30 [‐6.37, 8.97]
1.5 Coffee [+milk on request] v Standard Fast (+ H2‐receptor antagonists)	1	100	Mean Difference (IV, Random, 95% CI)	4.60 [‐0.92, 10.12]
1.6 Fruit Juice v Standard Fast (no H2‐receptor antagonists)	1	100	Mean Difference (IV, Random, 95% CI)	0.5 [‐6.50, 7.50]
1.7 Fruit Juice v Standard Fast (+ H2‐receptor antagonists)	2	153	Mean Difference (IV, Random, 95% CI)	4.24 [‐0.27, 8.76]
1.8 Other Fluids v Standard Fast (no H2‐receptor antagonists)	4	470	Mean Difference (IV, Random, 95% CI)	2.19 [‐0.63, 5.00]
1.9 Other Fluids v Standard Fast (+ H2‐receptor antagonists)	1	30	Mean Difference (IV, Random, 95% CI)	‐4.60 [‐9.62, 0.42]
2 Gastric Contents ‐ pH Show forest plot	24		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Water v Standard Fast	14	742	Mean Difference (IV, Random, 95% CI)	0.09 [‐0.10, 0.29]
2.2 Water v Standard Fast (no H2‐receptor antagonists)	9	517	Mean Difference (IV, Random, 95% CI)	0.07 [‐0.15, 0.28]
2.3 Water v Standard Fast (+ H2‐receptor antagonists)	5	225	Mean Difference (IV, Random, 95% CI)	0.28 [‐0.25, 0.82]
2.4 Coffee [+milk on request] v Standard Fast (no H2‐receptor antagonists)	1	98	Mean Difference (IV, Random, 95% CI)	0.23 [‐0.34, 0.80]
2.5 Coffee [+milk on request] v Standard Fast (+ H2‐receptor antagonists)	1	82	Mean Difference (IV, Random, 95% CI)	‐0.56 [‐1.35, 0.23]
2.6 Fruit Juice v Standard Fast (no H2‐receptor antagonists)	1	95	Mean Difference (IV, Random, 95% CI)	0.0 [‐0.50, 0.50]
2.7 Fruit Juice v Standard Fast (+ H2‐receptor antagonists)	2	110	Mean Difference (IV, Random, 95% CI)	‐0.76 [‐1.50, ‐0.03]
2.8 Other Fluids v Standard Fast (no H2‐receptor antagonists)	4	381	Mean Difference (IV, Random, 95% CI)	0.21 [0.00, 0.42]
2.9 Other Fluids v Standard Fast (+ H2‐receptor antagonists)	1	30	Mean Difference (IV, Random, 95% CI)	0.80 [‐0.65, 2.25]
3 Gastric Contents ‐ Cyanoconolamin (ml) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Water v Standard Fast (no H2‐receptor antagonists)	1	100	Mean Difference (IV, Fixed, 95% CI)	‐3.0 [‐12.26, 6.26]
3.2 Carbohydrate drink v Standard Fast (no H2‐receptor antagonists)	1	92	Mean Difference (IV, Fixed, 95% CI)	‐4.0 [‐13.03, 5.03]
4 Gastric Contents ‐ BSP (%) Show forest plot	4		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 Water v Standard Fast	4	240	Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.27, 0.10]
4.2 Water v Standard Fast (no H2‐receptor antagonists)	2	120	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4.3 Water v Standard Fast (+ H2‐receptor antagonists)	2	120	Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.27, 0.10]

Comparison 4. Type of Intake ‐ Fluid v Standard Fast

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Comparison 5. Type of Intake ‐ Fluid 1 [F1] v Fluid 2 [F2]

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gastric Contents ‐ Volume (ml) Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 [F1] Orange Juice v [F2] Coffee (no H2‐receptor antagonist)	1	100	Mean Difference (IV, Fixed, 95% CI)	‐0.80 [‐8.66, 7.06]
1.2 [F1] Orange Juice v [F2] Coffee (+ H2‐receptor antagonist)	1	100	Mean Difference (IV, Fixed, 95% CI)	0.5 [‐5.86, 6.86]
1.3 [F1] Apple Juice v [F2] Assam Tea (+ H2‐receptor antagonist)	1	40	Mean Difference (IV, Fixed, 95% CI)	10.70 [1.82, 19.58]
1.4 [F1] Water v [F2] Carbohydrate Drink (no H2‐receptor antagonist)	1	162	Mean Difference (IV, Fixed, 95% CI)	‐4.0 [‐15.11, 7.11]
1.5 [F1] Water v [F2] Isotonic drink (+ H2‐receptor antagonists)	1	30	Mean Difference (IV, Fixed, 95% CI)	1.70 [‐2.59, 5.99]
2 Gastric Contents ‐ pH values Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 [F1] Orange Juice v [F2] Coffee (no H2‐receptor antagonist)	1	95	Mean Difference (IV, Fixed, 95% CI)	‐0.23 [‐0.80, 0.34]
2.2 [F1] Orange Juice v [F2] Coffee (+ H2‐receptor antagonist)	1	79	Mean Difference (IV, Fixed, 95% CI)	‐0.24 [‐1.18, 0.70]
2.3 [F1] Apple Juice v [F2] Assam Tea (+ H2‐receptor antagonist)	1	40	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐3.09, ‐0.11]
2.4 [F1] Water v [F2] Carbohydrate Drink (no H2‐receptor antagonist)	1	85	Mean Difference (IV, Fixed, 95% CI)	‐0.10 [‐0.78, 0.58]
2.5 [F1] Water v [F2] Isotonic drink (+ H2‐receptor antagonists)	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.90 [‐2.39, 0.59]
3 Gastric Contents ‐ Cyanoconolamin (ml) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 [F1] Water v [F2] Carbohydrate Drink (no H2‐receptor antagonist)	1	92	Mean Difference (IV, Fixed, 95% CI)	1.0 [‐6.97, 8.97]

Comparison 5. Type of Intake ‐ Fluid 1 [F1] v Fluid 2 [F2]

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Comparison 6. Volume of Intake ‐ Volume of Fluid v Standard Fast

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gastric Contents ‐ Volume (ml) Show forest plot	24		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Low Volume Fluid Intake v Standard Fast	17	983	Mean Difference (IV, Random, 95% CI)	‐1.43 [‐3.56, 0.71]
1.2 Low Volume Fluid Intake v Standard Fast (no H2‐receptor antagonists)	9	572	Mean Difference (IV, Random, 95% CI)	‐3.77 [‐8.04, 0.50]
1.3 Low Volume Fluid Intake v Standard Fast (+ H2‐receptor antagonists)	8	411	Mean Difference (IV, Random, 95% CI)	‐0.19 [‐1.98, 1.60]
1.4 High Volume Fluid Intake v Standard Fast (no H2‐receptor antagonists)	3	295	Mean Difference (IV, Random, 95% CI)	‐0.91 [‐8.46, 6.63]
1.5 High Volume Fluid Intake v Standard Fast (+ H2‐receptor antagonists)	1	53	Mean Difference (IV, Random, 95% CI)	3.0 [‐4.07, 10.07]
1.6 Unlimited Fluid Intake v Standard Fast	3	306	Mean Difference (IV, Random, 95% CI)	0.33 [‐4.38, 5.05]
2 Gastric Contents ‐ pH Show forest plot	24		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Low Volume Fluid Intake v Standard Fast	17	901	Mean Difference (IV, Random, 95% CI)	0.05 [‐0.15, 0.25]
2.2 Low Volume Fluid Intake v Standard Fast (no H2‐receptor antagonists)	9	542	Mean Difference (IV, Random, 95% CI)	0.10 [‐0.17, 0.36]
2.3 Low Volume Fluid Intake v Standard Fast (+ H2‐receptor antagonists)	8	359	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.43, 0.47]
2.4 High Volume Fluid Intake v Standard Fast (no H2‐receptor antagonists)	3	177	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.46, 0.50]
2.5 High Volume Fluid Intake v Standard Fast (+ H2‐receptor antagonists)	1	33	Mean Difference (IV, Random, 95% CI)	‐0.62 [‐2.21, 0.97]
2.6 Unlimited Fluid Intake v Standard Fast	3	306	Mean Difference (IV, Random, 95% CI)	0.19 [‐0.01, 0.39]
3 Gastric Contents ‐ Cyanoconolamin (ml) Show forest plot	2	142	Mean Difference (IV, Fixed, 95% CI)	‐3.50 [‐14.24, 7.24]

3.1 High Volume Fluid Intake v Standard Fast	2	142	Mean Difference (IV, Fixed, 95% CI)	‐3.50 [‐14.24, 7.24]
4 Gastric Contents ‐ BSP (%) Show forest plot	4		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 Low Volume Fluid Intake v Standard Fast	4	240	Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.27, 0.10]
4.2 Low Volume Fluid Intake v Standard Fast (no H2‐receptor antagonist)	2	120	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4.3 Low Volume Fluid Intake v Standard Fast (+ H2‐receptor antagonist)	2	120	Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.27, 0.10]

Comparison 6. Volume of Intake ‐ Volume of Fluid v Standard Fast

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Comparison 7. Volume of Intake ‐ Volume 1 [V1] v Volume 2 [V2]

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gastric Contents ‐ Volume (ml) Show forest plot	1	50	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐11.09, 11.09]

1.1 Low Volume v High Volume of Fluid Intake	1	50	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐11.09, 11.09]
2 Gastric Contents ‐ pH Show forest plot	1	50	Mean Difference (IV, Fixed, 95% CI)	0.5 [0.05, 0.95]

2.1 Low Volume v High Volume of Fluid Intake	1	50	Mean Difference (IV, Fixed, 95% CI)	0.5 [0.05, 0.95]

Comparison 7. Volume of Intake ‐ Volume 1 [V1] v Volume 2 [V2]

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Comparison 8. 'At‐Risk' Patient Populations

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gastric Contents ‐ Volume (ml) Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Obese ‐ High Volume Clear Fluid 120 minutes Preop v Standard Fast	1	130	Mean Difference (IV, Random, 95% CI)	19.0 [7.47, 30.53]
1.2 Postpartum ‐ Low Volume Water 120‐180 minutes Preop v Standard Fast	2	140	Mean Difference (IV, Random, 95% CI)	1.37 [‐2.71, 5.44]
2 Gastric Contents ‐ pH Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Obese ‐ High Volume Clear Fluid 120 minutes Preop v Standard Fast	1	130	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.40, 0.44]
2.2 Postpartum ‐ Low Volume Water 120‐180 minutes Preop v Standard Fast	2	140	Mean Difference (IV, Random, 95% CI)	0.10 [‐0.17, 0.37]

Comparison 8. 'At‐Risk' Patient Populations

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