Steve Green, MD Profile
Steve Green, MD

@SteveGreenMD

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Professor of Emergency Medicine, Loma Linda U; Deputy Editor, Ann Emerg Med; Co-Chair, International Committee for the Advancement of Procedural Sedation

https://t.co/lcuL0utLcF
Joined September 2018
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@mgirwin
MICHAEL G IRWIN
@mgirwin
6 years
Two hours too long: time to review fasting guidelines for clear fluids https://t.co/AO8TFs00VJ Excellent-same applies to procedural sedation An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children
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@SteveGreenMD
Steve Green, MD
@SteveGreenMD
6 years
There are no modern published reports of aspiration-associated mortality with procedural sedation in children or in healthy adults (ASA I or II). Current concerns regarding aspiration vastly exceed the actual risk. https://t.co/FYgd3AFjok #NotSoFast @Anaes_Journal
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@SteveGreenMD
Steve Green, MD
@SteveGreenMD
6 years
Fasting does not guarantee an empty stomach. Research has verified that fasting-compliant patients sent for GA commonly have intra-gastric fluids & solids. Thus, anesthesia isβ€”and likely always has beenβ€”regularly & widely administered to those with appreciable gastric contents.
@Anaes_Journal
𝘈𝘯𝘒𝘦𝘴𝘡𝘩𝘦𝘴π˜ͺ𝘒
@Anaes_Journal
6 years
Imaging has frequently identified gastric fluids and solids in pre-operative patients compliant with existing fasting guidelines, indicating that general anesthesia is regularly and widely performed in patients whose stomachs are not empty. Food for thought? #NotSoFast
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@SteveGreenMD
Steve Green, MD
@SteveGreenMD
6 years
Fasting strategies for procedural sedation in healthy patients need not always be the same as general anesthesia, given substantially lower theoretical and observed risk. #NotSoFast
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@SteveGreenMD
Steve Green, MD
@SteveGreenMD
6 years
Sedation is not anesthesia. Procedural sedation intentionally targets a state in which protective airway reflexes are retained, while general anesthesia denotes a state in which they are often absent. #NotSoFast
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@SteveGreenMD
Steve Green, MD
@SteveGreenMD
6 years
Fasting often substantially exceeds recommended time thresholds and has known adverse consequences, eg, irritability, dehydration, hypoglycemia. There is no observed association between aspiration and compliance with common fasting guidelines. #NotSoFast @Anaes_Journal
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@SteveGreenMD
Steve Green, MD
@SteveGreenMD
6 years
To help readers better understand our article, we invite you to review the summary points for our evidentiary review at: https://t.co/Dynf1TYHZV
@Anaes_Journal
𝘈𝘯𝘒𝘦𝘴𝘡𝘩𝘦𝘴π˜ͺ𝘒
@Anaes_Journal
6 years
πŸ”We are delighted to publish the first fasting and aspiration prevention recommendations specific to procedural sedation! Join us for tonight's TweetChat at 7pm GMT! @SteveGreenMD @mgirwin @gandolfattoNV @LucyOsoyoos @RobackMark @dougcarlson1 πŸ”— https://t.co/dTBLoCMU0A
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@SteveGreenMD
Steve Green, MD
@SteveGreenMD
6 years
The evidence supporting current fasting practice is weak, particularly for procedural sedation. We have comprehensively reviewed this literature, as published tomorrow in Anaesthesia. We invite you to review our bulleted summary points at: https://t.co/HN1TeGjum1 #NotSoFast
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