Pre-operative Fasting Guidelines

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PRE-OPERATIVE FASTINGGUIDELINES


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INTRODUCTION

preoperative fasting is defined as a prescribedperiod of time before a procedure when patients are

not allowed the oral intake of liquids or solids Perioperative pulmonary aspiration is defined as

aspiration of gastric contents occurring afterinduction of anesthesia, during a procedure, or in theimmediate period after surgery.

nil per osNPO: nothing by mouth

------------------------------------------Anesthesiology 2011; 114:495511


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enhance the quality and efficiency

of anesthesia care

the cost-effective use of perioperative

preventive medication, increased patientsatis-faction, avoidance of delays and

cancellations, decreased risk of dehydration

or hypoglycemia from prolonged fasting, and

the minimization of perioperative morbidity.

Anesthesiology 2011; 114:495511


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stimulate evaluation of clinical

practices

Clinical practices include, but are not limited

to, with-holding solids and liquids forspecified time periods before surgery, and

prescribing pharmacologic agents to reduce

gastric volume and acidity.



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reduce the severity of complications relatedto perioperative pulmonary aspiration of

gastric contents.

Complications of aspiration include, but are

not limited to, aspiration pneumonia,respiratory disabilities, and related

morbidities



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Metabolic response

Conventional preoperative fasting time may

aggravate insulin resistance and influence the

elevation of glycemia, especially because it is

frequently longer than the expected 6-8 h and may

be as long as 10-16 h

overnight fasting may cause variable degrees of

dehydration depending on the ultimate duration ofthe fasting period.


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ASA guideline

Ingested Material Minimum Fasting Period

Clear liquids 2 h Breast milk 4 h

Infant formula 6 h

Nonhuman milk 6 h Light meal 6 h


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The intake of milk

Breast milk may be given up to 4hrs beforeinduction of anaesthesia.

Formula milk or cows milk may be given up

to 6hrs before induction of anaesthesia.

Some special formulated milk for baby under

< 6 Mo ( Low casein / non enriched ) may be

given 4 hour before induction


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Pre-op Fasting

The intake of oral fluids. The volume of liquid ingested is less important thanthe type of liquid ingested.

Tea and coffee with milk are acceptable up to 6 hrs before induction of

anaesthesia. The volume of administered fluids does not appear to have an impact on

patients residual gastric volume and gastric pH, when compared to a standardfasting regimen. Therefore, patients may have unlimited amounts of water andother clear fluid up to two hours before induction of anaesthesia.

* In practice, a clear fluid is one through which newsprint can be read.


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Pre-op Fasting

The intake of solid foods

A minimum pre-op fasting time of 6hrs is recommended for food

(solids and milk). Fried or fatty meal 8hrs is recommended before induction of

anaesthesia.

Chewing gum and sweets

Chewing gum should not be permitted on the day of surgery. Sweets are solid food. A minimum of 6hrs pre-op fasting time is

recommended.


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Pre-op Fasting in High* Risk

General Recommendations

Higher-risk patients should follow the same pre op fasting regime

as healthy adults, unless contraindicated. In addition, theanaesthetic team should consider further interventions, asappropriate to the overall clinical situation.

*High risk of regurgitation and aspiration; patients include thosewith obesity, gastro-oesophageal reflux and diabetes.


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Adults and Children undergoing emergency

surgery should be treated as if they have afull stomach. If possible, the patient should

follow normal fasting guidance to allow

gastric emptying


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Pre-Op Fasting in Labor

The ASA NPO guidelines from 2007 state

that during labor, oral intake of modestamounts of clear liquids may be allowed for

uncomplicated laboring patients.

Solid foods should be avoided in labor.

For medically complicated patients atincreased risk for aspiration (e.g., morbid

obesity) or when fetal heart rate tracings

change, no food or drink should be allowed.


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Gregory's Pediatric Anesthesia

Miller's Anesthesia

Anesthesiology 2011; 114:495511Practice Guidelines forPreoperative Fasting and the Useof Pharmacologic Agents to Reduce

the Risk of Pulmonary Aspiration: Application to Healthy Patients

Undergoing Elective Procedures

Pre-operative Assessment and Patient Preparation The Role of the

Anaesthetist The Association of Anaesthetists of Great Britain and

Ireland

Anesthesia Student Survival Guide, Jesse M. Ehrenfeld, MD, MPH

Richard D. Urman, MD, MBAScott Segal, MD, MHCM Springer New

York Dordrecht Heidelberg London

Pre operative fasting , 2003 , hospital authority, Hongkong

Pre-operative Fasting Guidelines

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