Preoperative Fasting (NPO) Guidelines - ADULT

Purpose

The following policy sets departmental recommendations for the implementation of preoperative fasting (NPO) guidelines prior to adult surgical procedures performed at UTMB.

This policy is designed primarily to deal with those elective surgical cases in which the Anesthesiologist is informed that the patient has either eaten food or drank liquids in the preceding eight hours prior to surgery.

Audience

The information in this policy is for use by all M.D.'s who direct the administration of anesthesia, as well as for all residents and CRNA's who administer and/or monitor patients receiving anesthesia.

Policy

A brief history and physical exam, review of current medications and drug allergies, assessment of physical status, review of relevant diagnostic studies and determination of relative risk for aspiration must be completed each patient.

No aspiration risk/Elective procedure

The following guidelines are recommended for those patients who after thorough review, are determined to have no known risk factors (see below) for aspiration and in whom an elective surgical procedure is planned.

No solid food in the six (6) hours preceding scheduled surgery.
Unrestricted clear fluids until two (2) hours before scheduled surgery.
Oral medications one (1) to two (2) hours before scheduled surgery with up to 150 ml of water.

Aspiration risk factors present/Elective procedure

The following guidelines are recommended for those patients who after thorough review, are determined to have risk factors (see below) for aspiration and in whom an elective surgical procedure is planned.

No solid food or liquid in the six (6) hours preceding scheduled surgery.
Oral medications one (1) to two (2) hours before scheduled surgery with up to 150 ml of water.
H2 receptor antagonists should be considered for patients who may be at increased risk for aspiration.

Emergent surgery

The following guidelines are recommended for those patients who are deemed to require emergent surgery for which waiting the above recommended times is not feasible.

H2 receptor antagonists should be considered for patients who may be at increased risk for aspiration.
Consideration should be given to the use of an appropriate regional technique.
If General anesthesia must be used, then induction of anesthesia should be performed using the rapid sequence procedure after an appropriate period of preoxygenation.
The airway should always be secured in these patients utilizing an endotracheal tube.

Definitions

The above are some of the more common examples of aspiration risks. This list is not meant to be all-inclusive.

References

Stoelting RK: NPO and aspiration: New perspectives. ASA Refresher Course. 1997;111 1-7.

Tasch MD, Stoelting RK. Aspiration prevention, prophylaxis, and treatment. In: Benumof JL (ed.). Airway Management. Mosby, St. Louis. 1996:183-201.

Strunin L. How long should patients fast before surgery? Time for new guidelines. Br J Anesth 1993:70:1-2.