Preoperative fasting time: is the traditional policy changing? Results of a national survey

Several papers in the 1980s questioned the wisdom of withholding clear liquids for more than 3 h before elective surgery. Furthermore, recent papers have suggested relaxing the current NPO after midnight (Latin: Nulla per os; or "nothing by mouth") practice in children and adults. To see whether the policy and practice regarding NPO status before elective surgery have changed in the United States, we performed a national survey. In November 1992, 300 questionnaires were mailed to the chairpersons of 114 university anesthesiology programs and the medical directors of 186 randomly selected, free-standing ambulatory surgery centers. Seventeen simple questions were asked regarding their NPO policy and practice guidelines before elective operations. Replies were tabulated, and the data were descriptively analyzed via frequency distribution. We received 191 replies, 85 from the university programs and 106 from the free-standing units (75% and 57% response rates, respectively) from all six time zones of the United States. Fifty-seven percent of the responders stated that they had revised their NPO policy during the last 3 yr, whereas 39% reported that they had not changed their NPO policy. One hundred percent of the respondents who allowed clear liquids considered water to be acceptable for adults, whereas 94% considered water acceptable in the pediatric population. Eighty-one percent of the responders denied the use of routine prophylaxis for acid aspiration. None of the responders reported an adverse outcome which could be attributable to the recent change in the NPO guidelines. On a related question, 16% of all the respondents stated that they would cancel the operation if a patient arrived for an elective outpatient surgical procedure after consuming coffee with cream 2 h before operation. In conclusion, our survey revealed that 69% of anesthesiologists in the United States have either changed their NPO policy or are flexible in their practice in allowing clear liquids before elective operation in children and 41% have done so for adult patients. The most frequently allowed clear liquids in the adult and pediatric population were water and apple juice. None of the respondents reported any medical adverse event associated with the institution of a flexible NPO policy.