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Patients undergoing cardiac catheterization have historically been kept fasted in anticipation of potential complications or need for sedation. However, cardiac catheterization is now considered extremely safe and this questions the need for mandatory fasting.
We randomly assigned patients referred for elective or in-hospital cardiac catheterization to overnight fasting (OF) or limited-fasting (LF). The OF group were told to fast from midnight as per standard practice. The LF group was allowed to eat up to 2 hours prior to the planned procedure time. Emergency procedures were excluded as were patients with SaO2<92% (air) at baseline and patients with prior stroke or swallowing difficulties.
515 patients (n=266 OF, n=249 LF, outpatients 35%) were included. 257 patients underwent coronary angiography; the remainder underwent coronary angiography with ad hoc percutaneous coronary intervention (PCI). More patients in the LF group requiring sedation than the OF group (6.8% vs 2.6%, p=0.04) due to anxiety or radial spasm. More patients in the OF group required fluid bolus for hypotension (4% vs. 9.4%, p=0.02). 2 patients in the OF group reported feeling nauseous post procedure, unrelated to the use of sedatives and did not lead to complications. Resting SaO2 did not drop below 92% in any patient.
Allowing patients to eat and drink up until 2 hours before cardiac catheterization appeared to be well tolerated and safe and may avoid pre-procedural hypotension. Larger cohorts need to be studied to confirm these preliminary findings.