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Nulla Per Os (NPO) guidelines: time to revisit?

Sabine Friedrich¹, Patrick Meybohm, Peter Kranke

¹Department of Anaesthesia, Critical Care Medicine and Pain Medicine, University Hospital Wuerzburg, Germany.

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|October 7, 2020

Summary

Prolonged preoperative fasting is common, but allowing clear fluids until the operating room may improve patient comfort without increasing adverse events. Further research is needed to evaluate liberal clear fluid fasting in adults.

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Area of Science:

Anesthesiology
Surgical Care
Patient Safety

Background:

Current preoperative fasting guidelines are often generalized for elective procedures, irrespective of setting.
Prolonged preoperative fasting is prevalent, despite the low incidence of aspiration.
Recent discussions focus on revising preoperative fasting guidelines.

Purpose of the Study:

To review current practices and evidence regarding preoperative fasting guidelines.
To evaluate the impact of prolonged fasting versus liberal fluid intake on patient outcomes.
To explore potential improvements in patient comfort and surgical scheduling flexibility.

Main Methods:

Review of existing literature and clinical practices concerning preoperative fasting.
Analysis of data on clear fluid intake durations and associated adverse events.
Comparison of outcomes between prolonged fasting and liberal fluid intake protocols, particularly in pediatric populations.

Main Results:

Up to 80% of patients experience prolonged clear fluid fasting (>4 hours), with mean durations exceeding 16 hours.
Prolonged fasting is linked to adverse effects including hemodynamic instability, postoperative delirium, discomfort, and extended hospital stays.
Liberal clear fluid intake up to 1 hour pre-anesthesia showed no increased adverse events in children, leading to recommendations from anesthesia societies.

Conclusions:

Allowing clear fluids until the operating room may reduce prolonged fasting and enhance patient comfort.
This approach could offer flexibility in operating room scheduling.
The safety and feasibility of liberal clear fluid fasting in adults require further investigation.