Related Experiment Videos
"Nulla per os [NPO] after midnight" reassessed
1Ophthalmology, Brown University School of Medicine, Providence, RI, USA.
Rhode Island Medicine
|December 1, 1995
Summary
Fasting does not empty the stomach, and clear liquids pose no aspiration risk. Current preoperative fasting guidelines, including NPO after midnight, should be abandoned for patient benefit.
Area of Science:
- Anesthesiology
- Surgical Patient Care
Background:
- Traditional preoperative fasting (NPO after midnight) is based on the incorrect assumption that fasting empties the stomach.
- Studies show fasting does not reduce gastric volume or acidity, and clear liquid intake does not increase aspiration risk.
- Current practices may be detrimental to patient well-being and recovery.
Purpose of the Study:
- To challenge the traditional NPO after midnight guideline.
- To recommend evidence-based guidelines for preoperative fluid and food intake.
- To improve patient comfort and safety in the perioperative period.
Main Methods:
- Review of existing scientific literature on gastric physiology and aspiration risk.
- Analysis of the benefits and risks associated with preoperative fluid intake.
- Development of updated, patient-centered preoperative fasting recommendations.
Main Results:
- Fasting does not significantly decrease gastric volume or acidity.
- Preoperative clear liquid intake does not increase the risk of pulmonary aspiration.
- Withholding fluids preoperatively offers no benefit and may be harmful.
Conclusions:
- Adults and children (ASA Class I-II) should drink clear fluids up to 2 hours before elective surgery.
- Solid food and non-clear liquids should be withheld for at least 6 hours before surgery.
- Patients under local anesthesia can consume normal meals and fluids as desired.