NPO-Fasting
Fasting-NPO-Nothing Per OS
Elective Surgery
ASA Minimum Fasting Recommendations
Clear Liquids at least 2 hours
Breast Milk at least 2 hours
Infant Formula at least 6 hours
Nonhuman milk at least 6 hours
Light Meal at least 6 hours
Fried Foods, Fatty Foods, or Meal: 8 hours or more
“The guidelines may not apply to or may need to be modified for patients with coexisting diseases or conditions that can affect gastric emptying or fluid volume (e.g., pregnancy, obesity diabetes, hiatal hernia, gastroesophageal reflux disease ileus or bowel obstruction, emergency care, or enteral tube feeding) and patients in whom airway management might be difficult.” ASA 2017 p.377
ASA defines clear liquids as “water and fruit juices without pulp, carbonated beverages, carbohydrate-rich nutrition drinks, clear teas and black coffee” (ASA 2017 p.379)
Also apply to "Procedural Sedation": "before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia" (ASA 2017 p.380)
"The guidelines do not apply to patients who undergo procedures with no anesthesia or only local anesthesia when upper airway protective reflexes are not impaired and when no risk factors for pulmonary aspiration are apparent." (ASA 2017 p.377)
Enhanced Recovery Exclusions
Exclude delayed gastric emptying, gastrointestinal motility disorder, emergent surgeries from ERAS Pre-op Complex Carbohydrate and clear liquids:
"Oral fluids including carbohydrates may not be administered safely in patients with documented delayed gastric emptying or gastrointestinal motility disorders as well as in patients undergoing emergency surgery." 2018 ERAS Society p.669
Other Considerations
ASA defines clear liquids as “water and fruit juices without pulp, carbonated beverages, carbohydrate-rich nutrition drinks, clear teas and black coffee” (ASA 2017 p.379)
However, in some adults, may want to exclude sugar water such as fruit juices and soda pop (sugar and diet) because of possible adverse metabolic effects--hyperglycemia.
Additionally, allowing only water could put patient at risk for hyponatremia:
especially if receiving bowel preps.
This would suggest some possible benefit of "sports drinks" with balanced electrolytes.
Consider limiting black coffee or clear tea to 8 ounces on morning of surgery to have effect of preventing caffeine withdrawal but also avoiding dehydrating diuretic effects of caffeine.
No milk in coffee—ASA guidelines call for 6 hours NPO after milk.
Moderate Sedation
Must be prepared for sedation a level deeper than intended.
Deep sedation requires NPO.
If planning moderate sedation, then sound argument can be made for NPO.
"...a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature..."
"...a prudent practitioner would be unlikely to administer deep sedation to a child with a minor condition who just ate a large meal..."
AAP 2019
