I continue to be disappointed in the way breastfed babies are handled
preoperatively, so asked Dr. Paul Ting, editor of "Anesthesiology Guide"
if he knew of hard data on the subject.  He has given me permission to
pass on his responses.

> Thanks for writing... there actually is a consensus Practice Guideline
> issued by the American Society of Anesthesiologists.  It was recently
> updated based on new studies.  Here is the relevant quote:
>
> "The ASA Practice Guidelines for Preoperative Fasting suggests that patients undergoing elective surgery may be allowed to drink limited quantities of clear liquids up to two hours before surgery with permission from their physicians. Clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea and black coffee. These liquids should not include alcohol.
>
> Studies show that there are significant benefits to allowing patients to drink clear liquids up to two hours before surgery. Patients, especially children, are less anxious, better hydrated and may have fewer headaches and nausea after surgery. The developers of the guidelines have concluded that clear liquids are digested quickly, so the amount of liquid a patient drinks before anesthesia is not as important as what the patient drinks.
>
> The guidelines are more strict when it comes to breast milk, nonhuman milk and solid food. Breast milk is more easily digested than nonhuman milk but should not be given to babies less than four hours before surgery. The guidelines state that surgical patients should avoid solid food, nonhuman milk and infant formula for at least eight hours before surgery."

From the ASA guidelines:

> III. Preoperative fasting status (breast milk)
>
> There is insufficient published evidence to evaluate the relationship of the timing of breast milk intake before procedures to the incidence of emesis/reflux or pulmonary aspiration. The Consultants and Task Force
support a fasting period for breast milk of 4 hours for both neonates
and infants.
>
> Recommendations:
> It is appropriate to fast from intake of breast milk for 4 or more hours before procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e., monitored anesthesia care)
>
> Unfortunately the web version of the guidelines do not have the bibliography included.  The bottom of the page just says to contact the ASA if you are interested in the data and statistical methods used to come up with these recommendations.  So - I can't give you the specifics... but you'll note that they said there is "insufficient published evidence".
>
> Basically they treat breast milk as in-between clear liquids (2 hours) and non-human mild (6 hours)... which at least one study does support.
>
> Again, hope this helps!

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