We welcome the interest in our work1 from anaesthetic colleagues and respond to their areas of concern in turn.

Preprocedural starvation is indeed controversial. American Society of Anesthesiologists (ASA)/Royal College of Anaesthetists (RCA) fasting guidelines are designed for elective cases and are not necessarily practical for emergency department patients who require early intervention, or in whom airway manipulation is rare. A more practical guideline exists.2 The incidence of aspiration in emergency department procedural sedation is limited to one case (of a total that includes nearly 4000 patients given propofol3)with no adverse outcome. Vomiting rates …