Violating traditional NPO guidelines with PO contrast before sedation for computed tomography

Administration of PO contrast within 2 hours before sedation for abdominal computed tomography (CT) is controversial because it violates American Society of Anesthesiologists guidelines that recommend 2 hours of fasting for clear fluids before sedation.

This study aimed to review the administration of PO contrast for patients undergoing propofol sedation for abdominal CT and to evaluate the impact of violation of traditional 2-hour NPO guidelines on care.

Sedation records were reviewed from January 2010 to October 2011 from all patients who received PO contrast within 2 hours of propofol sedation for abdominal CT. A control group of patients receiving intravenous contrast only before propofol sedation and abdominal CT was reviewed. Demographics, time between PO contrast administration and sedation, and amount of PO contrast were recorded. Outcome measures including success of sedation and adverse events (vomiting, suctioning, use of O₂ or advanced airway, unplanned admissions) were recorded.

Eighty-five patients received PO contrast within 2 hours before sedation for abdominal CT; 21 controls were identified. No differences in demographics or outcome measures were seen. No significant differences were seen in rates of interventions or adverse outcomes between groups. Median time between the successive PO contrast doses and propofol administration was 1.6 hours and 0.6 hours.

Administering oral contrast material within 2 hours of propofol sedation for abdominal CT in children seems to be relatively safe compared with those sedated after traditional NPO time frames.