PRE-OPERATIVE FASTING GUIDELINES

INTRODUCTION

preoperative fasting is defined as a prescribed period 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 after induction of anesthesia, during a procedure, or in the immediate period after surgery. nil per osNPO: nothing by mouth

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enhance the quality and efficiency of anesthesia care

the cost-effective use of perioperative preventive medication, increased patient satis-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

stimulate evaluation of clinical practices

Clinical practices include, but are not limited to, with-holding solids and liquids for specified time periods before surgery, and prescribing pharmacologic agents to reduce gastric volume and acidity.

Anesthesiology 2011; 114:495511

reduce the severity of complications related to 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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Gastric Emptying

Presented as half time ( time taken to empty half of the content into duodenum) Water 12 min, breast milk 25 min, solid food 44 min Need 5 half time to empty 95% Addition oil/fat prolonged 50% Anxiety, stress, pain prolonged gastric emptying
Pre operative fasting , 2003 , hospital authority, Hongkong

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 of the fasting period.

ASA guideline
Ingested Material Minimum Fasting Period Clear liquids 2h Breast milk 4h Infant formula 6h Nonhuman milk 6h Light meal 6h

ASA guideline

These recommendations apply to healthy patients who are undergoing elective procedures. They are not intended for women in labor. The fasting periods noted above apply to patients of all ages. Examples of clear liquids include water, fruit juices with-out pulp, carbonated beverages, clear tea, and black coffee. Because nonhuman milk is similar to solids in gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period.

The intake of milk Breast milk may be given up to 4hrs before induction 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

Pre-op Fasting

The intake of oral fluids. The volume of liquid ingested is less important than the 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 standard fasting regimen. Therefore, patients may have unlimited amounts of water and other clear fluid up to two hours before induction of anaesthesia.

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

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.

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, the anaesthetic team should consider further interventions, as appropriate to the overall clinical situation.

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

Pre-Op Fasting in Emergency Setting

Adults and Children undergoing emergency surgery should be treated as if they have a full stomach. If possible, the patient should follow normal fasting guidance to allow gastric emptying

Pre-Op Fasting in Labor

The ASA NPO guidelines from 2007 state that during labor, oral intake of modest amounts of clear liquids may be allowed for uncomplicated laboring patients. Solid foods should be avoided in labor. For medically complicated patients at increased risk for aspiration (e.g., morbid obesity) or when fetal heart rate tracings change, no food or drink should be allowed.

Gregory's Pediatric Anesthesia Miller's Anesthesia Anesthesiology 2011; 114:495511Practice Guidelines for Preoperative 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