Developing Comprehensive Nil Per Os Guidelines for the Pediatric Anesthesiologist in 2025.

Area of Science:

• Anesthesiology
• Pediatric Medicine
• Surgical Care

Background:

• The American Society of Anesthesiologists (ASA) released updated preoperative fasting guidelines in 2023.
• Existing guidelines for nil per os (NPO) orders present interpretation challenges for pediatric patients.
• Aspiration risk remains a concern in elective pediatric procedures.

Purpose of the Study:

• To develop modified pediatric anesthesia NPO guidelines.
• To address ambiguities in current ASA fasting recommendations for children.
• To standardize preoperative fasting protocols within an institution.

Main Methods:

• Review of existing published evidence on preoperative fasting.
• Consensus development among anesthesiology faculty.
• Adaptation of ASA guidelines for a pediatric population.

Main Results:

• Institution-specific modified pediatric NPO guidelines were created.
• Implementation led to a more consistent approach to preoperative care.
• Guidelines provide clearer direction for managing pediatric fasting.

Conclusions:

• Modified pediatric anesthesia NPO guidelines improve preoperative care consistency.
• Evidence-based consensus can refine existing national guidelines.
• Standardized NPO protocols benefit patients, families, and providers.