Journal List > J Korean Med Assoc > v.63(3) > 1143895

Yong: Preparative fasting before contrast-enhanced computed tomography

Abstract

Many hospitals have patients perform preparative fasting prior to contrast-enhanced computed tomography to prevent nausea, vomiting, and accompanying aspiration pneumonia. This policy has been regarded as reasonable because there are many side effects such as vomiting when ionic high-osmolar contrast media are used. Recent advancements in contrast media development, side effects such as nausea and vomiting have markedly decreased. However, fasting prior to the contrast-enhanced computed tomography examination is still customary. While debatable, it is not clear that fasting prior to the use of contrast media has a beneficial effect on the prevention of vomiting. On the contrary, excessive fasting can cause patient dissatisfaction, dehydration, and exhaustion. Therefore, before using contrast media, the duration of fasting should be determined based on consideration of the risks, benefits, and patient's comfort. In particular, to prevent dehydration, limitation of liquid intake during fasting is not recommended.

REFERENCES

1. Han S, Yoon SH, Lee W, Choi YH, Kang DY, Kang HR. Management of adverse reactions to iodinated contrast media for computed tomography in Korean referral hospitals: a survey investigation. Korean J Radiol. 2019; 20:148–157.
crossref
2. Manhire AR, Dawson P, Dennet R. Contrast agent-induced emesis. Clin Radiol. 1984; 35:369–370.
crossref
3. Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media: a report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990; 175:621–628.
crossref
4. Oowaki K, Saigusa H, Ojiri H, Ariizumi M, Yamagisi J, Fukuda K, Tada S. Relationship between oral food intake and nausea caused by intravenous injection of iodinated contrast material. Nihon Igaku Hoshasen Gakkai Zasshi. 1994; 54:476–479.
5. Maurer M, Heine O, Wolf M, Freyhardt P, Schnapauff D, Hamm B. Safety and tolerability of iobitridol in general and in patients with risk factors: results in more than 160,000 patients. Eur J Radiol. 2011; 80:357–362.
crossref
6. Palkowitsch PK, Bostelmann S, Lengsfeld P. Safety and tolerability of iopromide intravascular use: a pooled analysis of three non-interventional studies in 132,012 patients. Acta Radiol. 2014; 55:707–714.
crossref
7. Federle MP, Willis LL, Swanson DP. Ionic versus nonionic contrast media: a prospective study of the effect of rapid bolus injection on nausea and anaphylactoid reactions. J Comput Assist Tomogr. 1998; 22:341–345.
crossref
8. Nagamoto M, Gomi T, Terada H, Terada S, Kohda E. Evaluation of the acute adverse reaction of contrast medium with high and moderate iodine concentration in patients undergoing computed tomography. Radiat Med. 2006; 24:669–674.
crossref
9. Wendt-Nordahl G, Rotert H, Trojan L, Michel MS, Peters CR, Alken P, Knoll T. Intravenous contrast media in uroradiology: evaluation of safety and tolerability in almost 50,000 patients. Med Princ Pract. 2006; 15:358–361.
crossref
10. Vogl TJ, Honold E, Wolf M, Mohajeri H, Hammerstingl R. Safety of iobitridol in the general population and at-risk patients. Eur Radiol. 2006; 16:1288–1297.
crossref
11. Vijayalakshmi K, Kunadian B, Wright RA, Hall JA, Stewart MJ, Davies A, Sutton A, de Belder MA. A prospective randomised controlled trial to determine the early and late reactions after the use of iopamidol 340 (Niopam) and iomeprol 350 (Iomeron) in cardiac catheterisation. Eur J Radiol. 2007; 61:342–350.
crossref
12. Gomi T, Nagamoto M, Hasegawa M, Katoh A, Sugiyama M, Murata N, Kunihiro T, Kohda E. Are there any differences in acute adverse reactions among five low-osmolar non-ionic iodinated contrast media? Eur Radiol. 2010; 20:1631–1635.
crossref
13. Häussler MD. Safety and patient comfort with iodixanol: a postmarketing surveillance study in 9515 patients undergoing diagnostic CT examinations. Acta Radiol. 2010; 51:924–933.
crossref
14. Muller FH. Post-marketing surveillance of the safety profile of iodixanol in the outpatient CT setting: a prospective, multicenter, observational study of patient risk factors, adverse reactions and preventive measures in 9953 patients. Rofo. 2014; 186:1028–1034.
15. Zhang BC, Hou L, Lv B, Xu YW. Post-marketing surveillance study with iodixanol in 20 185 Chinese patients from routine clinical practices. Br J Radiol. 2014; 87:20130325.
16. Li X, Chen J, Zhang L, Liu H, Wang S, Chen X, Fang J, Wang S, Zhang W. Clinical observation of the adverse drug reactions caused by non-ionic iodinated contrast media: results from 109,255 cases who underwent enhanced CT examination in Chongqing, China. Br J Radiol. 2015; 88:20140491.
crossref
17. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011; 114:495–511.
18. Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, S⊘reide E, Spies C, in't Veld B. European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011; 28:556–569.
19. Lee BY, Ok JJ, Abdelaziz Elsayed AA, Kim Y, Han DH. Preparative fasting for contrast-enhanced CT: reconsideration. Radiology. 2012; 263:444–450.
crossref
20. Li X, Liu H, Zhao L, Liu J, Cai L, Zhang L, Liu L, Zhang W. The effect of preparative solid food status on the occurrence of nausea, vomiting and aspiration symptoms in enhanced CT examination: prospective observational study. Br J Radiol. 2018; 91:20180198.
crossref
21. Barbosa PNVP, Bitencourt AGV, Tyng CJ, Cunha R, Travesso DJ, Almeida MFA, Chojniak R. JOURNAL CLUB: Preparative fasting for contrast-enhanced ct in a cancer center: a new approach. AJR Am J Roentgenol. 2018; 210:941–947.
crossref
22. Kim YS, Yoon SH, Choi YH, Park CM, Lee W, Goo JM. Nausea and vomiting after exposure to non-ionic contrast media: incidence and risk factors focusing on preparatory fasting. Br J Radiol. 2018; 91:20180107.
crossref
23. Pimenta GP, de Aguilar-Nascimento JE. Prolonged preoperative fasting in elective surgical patients: why should we reduce it? Nutr Clin Pract. 2014; 29:22–28.
24. Nygren J. The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol. 2006; 20:429–438.
crossref
25. Sutherland AD, Maltby JR, Sale JP, Reid CR. The effect of preoperative oral fluid and ranitidine on gastric fluid volume and pH. Can J Anaesth. 1987; 34:117–121.
crossref
26. Motoi R, Yano I, Ozaki J, Hokoyama K, Yamamoto T, Fukatsu S, Ishizuka R, Matsumura Y, Taniguchi M, Higashimura K, Matsubara K. Effect of Water Intake on Allergy-like Events Associated with Non-ionic Iodine Contrast Agents. Yakugaku Zasshi. 2015; 135:1177–1784.
crossref
27. Korean Society of Radiology; Korean Academy of Asthma, Allergy and Clinical Immunology; Korea Institute of Drug Satety and Risk Management. Korean clinical guideline for the injectable iodine contrast media and gadolinium contrast media for MRI. 2nd ed.[Internet]. Seoul: Korean Academy of Asthma, Allergy and Clinical Immunology;2016. [cited 2020 Feb 14]. Available from:. http://www.allergy.or.kr/file/allergic2016.pdf.
28. Comite Interdisciplinaire de Recherche et de Travail sur les Agents de Contraste en Imagerie. Prescribing fasting before a radiological examinatio requiring the use of iodinated contrast media [Internet]. Paris: Societe Francaise de Radiologie;2005. [cited 2020 Feb 14]. Availlable from:. http://www.sfrnet.org/data/upload/files/a7e7222e420ac736c1256b6c0044cb07/contrast%20media%20prescribing%20fasting.pdf.
29. Kodzwa R. ACR manual on contrast media: 2018 Updates. Radiol Technol. 2019; 91:97–100.
TOOLS
Similar articles