The guidelines state, Anesthesiologists should recognize that these conditions can increase the likelihood of regurgitation and pulmonary aspiration and should modify these guidelines based upon their clinical judgment. A previous version states, The guidelines may not apply to, or may need to be modified for, patients with coexisting diseases or conditions that can affect gastric emptying or fluid volume (e.g., pregnancy, obesity, diabetes, hiatal hernia, gastroesophageal reflux disease, ileus or bowel obstruction, emergency care, or enteral tube feeding) and patients in whom airway management might be difficult. Requiring patients to abstain from food for longer than 8 hours, even if the optimal duration was unknown, would have been the most cautious approach, even if it was unenjoyable for patients
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Data suggests that this could involve modulation of urea cycle enzymes in the liver and changes in messenger RNA expression
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