From the Guidelines
You should fast for at least 2 hours before a tee (transesophageal echocardiogram) for clear liquids and 6 hours for solids. This recommendation is based on the most recent and highest quality study available, which suggests that fasting intervals identical to those recommended before elective anaesthesia may not be necessary for procedural sedation 1. The American Society of Anesthesiologists recommends a minimum of 2 hours for clear liquids and 6 hours for light meals before sedation 1.
Key Points to Consider
- Fasting is necessary to prevent aspiration (inhaling stomach contents into your lungs) during the procedure, as the TEE probe is inserted down your throat while you're sedated.
- The empty stomach also allows for better visualization of cardiac structures without food or fluid interference.
- If you have diabetes, inform your healthcare provider as they may need to adjust your fasting instructions and medication schedule to maintain safe blood sugar levels.
- If you take medications, ask your doctor which ones you should take on the day of the procedure - typically, essential medications like blood pressure pills can be taken with a small sip of water.
Evidence-Based Recommendations
The evidence suggests that the risk of aspiration during procedural sedation is low, and that fasting intervals may not need to be as strict as those recommended for general anaesthesia 1. However, it's still important to follow the recommended fasting guidelines to minimize the risk of complications. The most recent study on the topic, published in 2020, found that there is no conclusive evidence to support assertions about safe fasting intervals, and that current fasting recommendations are largely consensus-driven 1.
Patient-Specific Considerations
- Patients with certain medical conditions, such as diabetes, may need to adjust their fasting instructions and medication schedule to maintain safe blood sugar levels.
- Patients who are undergoing emergency procedures may not need to fast for the same amount of time as those undergoing elective procedures.
- Patients who are taking certain medications may need to adjust their medication schedule to ensure safe sedation.
From the Research
Fasting Duration Before TEE
There is no direct information available in the provided studies regarding the recommended fasting duration before undergoing a Transesophageal Echocardiography (TEE) procedure.
Sedation Strategies for TEE
- The choice of sedation strategy for TEE may depend on various factors, including patient co-morbidities and cardiac abnormalities 2.
- Studies have compared the efficacy and safety of different sedative agents, such as dexmedetomidine, propofol, midazolam, and midazolam-alfentanil combination, for TEE procedures 3, 4, 5.
- Dexmedetomidine has been shown to provide adequate sedation and hemodynamic control for awake, diagnostic TEE, with a lower risk of respiratory depression and hypotension compared to standard therapy 5.
- Propofol has also been found to be effective for sedation during TEE, allowing for rapid and effective sedation depth without the need for expensive antagonist agents 4.
Patient Preparation for TEE
- While the provided studies do not specifically address fasting duration, they do emphasize the importance of proper patient preparation and monitoring during TEE procedures 6, 2.
- Patients undergoing TEE may require sedation to ensure comfort and minimize discomfort or anxiety during the procedure 3, 4, 5.