Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures

2000 ◽  
Vol 44 (1) ◽  
pp. 47-48 ◽  
Author(s):  
MARK A. WARNER ◽  
ROBERT A. CAPLAN ◽  
BURTON S. EPSTEIN ◽  
CHARLES P. GIBBS ◽  
CANDACE E. KELLER ◽  
...  
Keyword(s):  
Practice Guidelines ◽  
Pulmonary Aspiration ◽  
Preoperative Fasting ◽  
Pharmacologic Agents

NPO Guidelines

2018 ◽  
pp. 407-414
Author(s):  
Glenn Mann ◽  
Dustin Liebling
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Practice Guidelines ◽  
Pulmonary Aspiration ◽  
Care Providers ◽  
Preoperative Fasting ◽  
Large Role ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Latin Term

Nil per os (NPO), a Latin term, that means “nothing by mouth” is used in medicine to describe the instruction to withhold fluids and solid foods from a person. Patients are kept NPO prior to a scheduled procedure in order to minimize the risk of emesis and pulmonary aspiration of gastric contents when placed under general anesthesia—the sequelae of which can have significant consequences on morbidity and mortality. The American Society of Anesthesiologists created practice guidelines for preoperative fasting that guides health care providers when a patient must abstain from drinking and eating prior to a procedure. NPO guidelines play a large role in the perioperative management of patients of all ages—from pediatrics to geriatrics—undergoing nonemergent procedures.

scholarly journals Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners

10.2196/15905 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e15905 ◽  
Author(s):  
Richard Neville Merchant ◽  
Navraj Chima ◽  
Olle Ljungqvist ◽  
Juliana Nai Jia Kok
Keyword(s):  
Fluid Intake ◽  
Evidence Base ◽  
Pulmonary Aspiration ◽  
Internet Survey ◽  
Preoperative Fasting ◽  
Clear Fluid ◽  
Safety Issues ◽  
Solid Foods ◽  
Gastric Contents ◽  
Operating Room Schedule

Background Pulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach. Despite a strong evidence base and the knowledge that fasting may be physiologically harmful and unpleasant for patients, the adoption of society guidelines recommending short fasting periods for clear fluids into clinical practice is uncertain. Objective This study aimed to determine the current practices of anesthetists with respect to fasting guidelines. Methods An electronic internet survey was distributed to anesthetists in Canada (CAN), Australia and New Zealand (ANZ), and Europe (EUR) during April 2014 to February 2015. The anesthetists were asked about fasting guidelines, their recommendations to patients for the consumption of clear fluids and solid foods, and the reasons and consequences if these guidelines were not followed. Results A total of 971 anesthetists completed the survey (CAN, n=679; ANZ, n=185; and EUR, n=107). Although 85.0% (818/962) of these participants claimed that their advice to patients followed current society guidelines, approximately 50.4% (476/945) enforced strict fasting and did not allow clear fluids after midnight. The primary reasons given were with regard to problems with a variable operating room schedule (255/476, 53.6%) and safety issues surrounding the implementation of clear fluid drinking guidelines (182/476, 38.2%). Conclusions Many anesthetists continue to follow outdated practices. The current interest in further liberalizing preoperative fluid intake will require more change in anesthesia culture.

Preoperative Fasting in the Pediatric Patient

2018 ◽  
Author(s):  
Nancy Hagerman ◽  
Eric Wittkugel
Keyword(s):  
Pediatric Patient ◽  
Venous Access ◽  
Pulmonary Aspiration ◽  
Evidence Based ◽  
Rare Occurrence ◽  
Preoperative Fasting ◽  
Prolonged Fasting ◽  
Gastric Contents ◽  
Difficult Venous Access ◽  
In Infants And Children

Preoperative fasting guidelines are designed to reduce the volume of gastric contents and to minimize the risk of pulmonary aspiration of gastric contents. Perioperative pulmonary aspiration in children is uncommon, with an incidence of between 1 and 10 per 10,000 anesthetics. It is associated with low morbidity and mortality. While fasting is important, it does not guarantee an empty stomach. Prolonged fasting in infants and children does not further reduce gastric volumes or increase safety but can be associated with unwanted effects such as irritability, parental dissatisfaction, hypoglycemia, dehydration, hypotension on the induction of anesthesia, difficult venous access, and possibly decreased compliance with the preoperative fast. Since pulmonary aspiration is a rare occurrence, few evidence-based recommendations for ideal fasting intervals exist. An understanding of the research involved in the creation of these guidelines is useful in ensuring the maximum safety of patients while minimizing the disadvantages of prolonged fasting.

Recommended guidelines for the treatment of chemotherapy-induced diarrhea.

1998 ◽  
Vol 16 (9) ◽  
pp. 3169-3178 ◽  
Author(s):  
S Wadler ◽  
A B Benson ◽  
C Engelking ◽  
R Catalano ◽  
M Field ◽  
...  
Keyword(s):  
Supportive Care ◽  
Practice Guidelines ◽  
Treatment Guidelines ◽  
Symptomatic Treatment ◽  
Published Data ◽  
Somatostatin Analogue ◽  
Optimal Dosage ◽  
The Cost ◽  
Recommended Guidelines ◽  
Pharmacologic Agents

PURPOSE Management of chemotherapy-induced diarrhea (CID) has customarily involved symptomatic treatment with opioids in conjunction with supportive care. Alternatively, patients refractory to conventional therapy have been given octreotide, a somatostatin analogue. Although this agent has been effective against CID, no widely accepted treatment guidelines that incorporate its use currently exist. An expert multidisciplinary panel was convened to formulate clinical practice guidelines for the treatment of CID. METHODS The panel reviewed clinical data on the management of CID reported in the literature and analyzed currently available tools used to assess CID. Expert consensus was applied when published data were insufficient. Panel members also considered the effect of CID on quality of life and the cost-effectiveness and efficacy of different pharmacologic approaches. Effective resolution of CID and decreases in the need for supportive care or hospitalization were considered to be primary goals in the formulation of the guidelines. RESULTS The panel formulated suggested practice guidelines for the management of CID that detail recommendations for the assessment and evaluation of diarrhea and the sequence and duration of administration of specific pharmacologic agents. CONCLUSION The consensus of the panel was that standardized assessment and management of diarrhea is required to effectively control CID. The panel agreed that further data from a National Cancer Institute (NCI)-sponsored intergroup trial is required to determine the optimal dosage of octreotide and its cost in the treatment of cancer. The panel also agreed that further clinical research is warranted to address significant questions about the most effective way to assess and treat CID.

scholarly journals Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved?

2021 ◽  
Author(s):  
Alexander R. Schmidt ◽  
James Fehr ◽  
Janice Man ◽  
Genevieve D’Souza ◽  
Ellen Wang ◽  
...  
Keyword(s):  
Median Time ◽  
Primary Outcome ◽  
Arrival Time ◽  
Task Force ◽  
Pulmonary Aspiration ◽  
Clear Liquid ◽  
Preoperative Fasting ◽  
Parental Compliance ◽  
Secondary Outcomes ◽  
American Society

Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force.Methods: Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before OR time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range).Results: 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30).Conclusions: This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time.

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