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Nil per os guidelines: what is changing, what is not, and what should?
Michael V Presta1, Sekar S Bhavani2, Basem B Abdelmalak3
1Department of Anesthesiology, Loyola University Medical Center, Maywood, IL, USA - mpresta1@gmail.com.
Minerva Anestesiologica
|November 6, 2018
Summary
Preoperative fasting guidelines (NPO) are evolving towards more permissive policies, allowing clear fluids up to two hours before surgery. This shift aims to reduce aspiration risk while addressing ongoing controversies and variability in clinical practice.
Area of Science:
- Anesthesiology
- Surgical Patient Care
Background:
- Preoperative nil per os (NPO) guidelines aim to minimize perioperative aspiration risk, preventing complications like unplanned hospital admissions.
- Historically, NPO guidelines have been controversial due to limited supporting data, leading to frequent updates by anesthesiology societies.
Purpose of the Study:
- To discuss controversies surrounding NPO guidelines, including their impact on aspiration risk, airway device selection, operating room efficiency, and procedural sedation.
Main Methods:
- Review of existing literature and guidelines on preoperative fasting.
- Discussion of current controversies and emerging evidence regarding NPO recommendations.
Main Results:
- Current NPO guidelines are becoming more permissive, with clear fluids often allowed up to two hours before elective surgery.
- This trend contributes to ongoing debate and variability in local NPO policies.
Conclusions:
- The evolution of NPO guidelines reflects new evidence but also fuels controversy and clinical practice variation.
- Further research is needed to reconcile differing recommendations and optimize patient safety and resource utilization.
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