NPO after midnight/Not quite

[49er]

https://www.mhealth.org/blog/2015/augus ... xperts-say

""For decades, anesthesiologists advised patients not to eat or drink at all after midnight the night before their surgery—a guideline referred to in the medical world as “NPO after midnight.”

But experts are now revisiting the old standard. New research suggests the “NPO after midnight” rule may be unnecessarily strict for patients scheduled to undergo surgery. In both 1999 and 2011, the American Society of Anesthesiologists recommended a minimum fast of two hours from clear liquids for all healthy patients undergoing elective procedures requiring general anesthesia, regional anesthesia or sedation/analgesia.

Still, many anesthesiologists continue adhere to “NPO past midnight” rule for all surgical patients.

“We have good evidence that drinking clear liquids until two hours before surgery is safe, but we continue to have this dogma about not eating or drinking anything after midnight, which is just a number picked out of the air,” said Anesthesiologist Joyce Wahr, MD, FAHA, the director of the new University of Minnesota Health Preoperative Assessment Center (PAC).""

Interestingly, when I corresponded with a surgeon before my 2015 septoplasty who has spoken out against the NPO after midnight practice, he said many patients are advised to do it so that hospital staff can have the option of moving people up for their procedures in case of a cancellation. But he said that rarely happens.

49er

[bigdave36]

I thought the midnight thing was kinda odd. I have had upper endoscopys at both 10am and 2:30 pm and was told no food no drink after midnight both times.

[chunkyfrog]

And when your surgery is postponed for HOURS, (which happens way too often),
it becomes debilitating--especially when the patient is prone to hypoglycemia.

[palerider]

And when your surgery is postponed for HOURS, (which happens way too often),
it becomes debilitating--especially when the patient is prone to hypoglycemia.

when I had this dialysis catheter put in, they did the NPO thing 'nothing after midnight'...

they started cutting at about 5pm.

[squid13]

May be it's a matter of who cleans up the puke when the patient gets sick from the anesthesia.

[palerider]

May be it's a matter of who cleans up the puke when the patient gets sick from the anesthesia.

it's not that, it's fear that if you do regurgitate, you'll aspirate it, then there's a whole new laundry list of problems.
what was worse in my case, I as awake an chatting with the OR crew the whole time... the had me NPO "just in case" they needed more sedation.

[squid13]

it's not that, it's fear that if you do regurgitate, you'll aspirate it

I know that, I guess I should of put some similes behind it. I just got home yesterday after 5 days in the hospital for a lower back surgery, laminectomy from L2 to L5 S1. They had to open up space for 10 nerve outlets plus some other stuff, took 2 hours and to my surprise I didn't throw up. Reason for 5 days was my Hemovac had to be 20 or below and I had a lot of drainage. I'll go with the nothing to eat or drink after midnight, your not going to starve or dry up for lack of a drink.

[Okie bipap]

When I had my laminectomy done about 18 months ago, I had NPO directions from my doctor. I didn't get into surgery until after 3:00 pm, and didn't get out of recovery until after 10:30. I was scheduled last because he knew he would find a big mess to clean up once he started the surgery. I had started to develop scoliosis in my lower back. Needless to say, when I finalising up I was rather thirsty.

[palerider]

it's not that, it's fear that if you do regurgitate, you'll aspirate it

I know that, I guess I should of put some similes behind it. I just got home yesterday after 5 days in the hospital for a lower back surgery, laminectomy from L2 to L5 S1. They had to open up space for 10 nerve outlets plus some other stuff, took 2 hours and to my surprise I didn't throw up. Reason for 5 days was my Hemovac had to be 20 or below and I had a lot of drainage. I'll go with the nothing to eat or drink after midnight, your not going to starve or dry up for lack of a drink.

well, I figured YOU did, but others might not

[49er]

Squid,

Even if patients don't suffer harm from the NPO after midnight rule which I disagree with, it is outdated and not based on the latest evidence.

https://www.healthstatus.com/health_blo ... nesthesia/

""Based on the realities of the modern medical landscape alone, many anesthesiologists are changing their guidelines for fasting before surgery, but there’s more. A number of prominent studies have been conducted in recent years showing that allowing patients to drink clear liquids up to two hours prior to surgery does not increase the risk of choking or other complications associated with not fasting prior to receiving anesthesia and actually reduces the risks of complications of surgery in general. Patients allowed to drink clear fluids experience less anxiety overall, require less IV fluids both during and after surgery, maintain a better metabolic rate when put under and recover better after the procedure is complete due to more steady blood sugar levels. Many patients also report feeling better overall without the stress of a complete fast on the day that an already stressful event is taking place.""

http://www.nursingcenter.com/cearticle? ... 0000-00020

Free registration is required

""Imagine two patients diagnosed with colon cancer, both scheduled for colectomy tomorrow morning: Susan Moore, who lives in New York City, and Paul Shaw, who lives in London. In all likelihood, Ms. Moore will be instructed to stop eating and drinking at midnight, whereas Mr. Shaw will probably be advised to drink a carbohydrate-rich clear liquid this evening as well as tomorrow morning and continue drinking clear liquids until two hours before surgery. Why the disparity? Preoperative fasting practices in the United States often disregard both the guidelines of the American Society of Anesthesiologists (ASA)1, 2 and the most current available evidence on the subject. The ASA recommends that healthy patients consume clear liquids up to two hours before elective surgery or conscious sedation but cautions that their guidelines aren't intended for women in labor and may need to be modified for patients with conditions that affect gastric emptying or fluid volume and those in whom airway management may be difficult.3-5 Evidence gathered throughout the world over the past 25 years not only supports the ASA guidelines, but establishes the health benefits of preoperative carbohydrate loading (through the consumption of carbohydrate-rich clear liquids) the evening before and the morning of surgery.6, 7 So why does the practice of prescribing NPO (non per os, or nothing by mouth) from midnight preceding a scheduled surgery persist-and how can clinicians promote a change?""

""In fact, increased awareness of risk factors for aspiration, together with modern anesthetic practices10 and improved anesthetic agents, has dramatically reduced the risk of pulmonary aspiration. Large studies show a progressive decline in aspiration incidence, from 0.15% in 194613 to 0.006% in 2002.14 As for stomach contents at the time of surgery, rates of gastric emptying vary widely, depending on the type of liquid or food consumed.3-5 Clear liquids leave the stomach almost immediately, while full liquids and solids remain for significantly longer periods. It's long been established that patients who drink clear liquids a few hours before surgery have significantly lower gastric volumes and similar or higher pH values compared with those who fast overnight, suggesting that drinking clear liquids may stimulate gastric emptying and dilute acidic gastric secretions, thereby lowering the risk of pulmonary aspiration and increasing patient safety.15-17""

[49er]

I thought the midnight thing was kinda odd. I have had upper endoscopys at both 10am and 2:30 pm and was told no food no drink after midnight both times.

Sorry to hear that. In the future, mention the ASA guidelines and ask why they aren't being adhered to. You'll probably get alot of pushback but in my opinion, patients have to start speaking up.

As an FYI, I chose not to argue about the NPO after midnight rule when I had my septoplasty. The surgeon had agreed to waive the requirement that I take antibiotics as a prophylactic measure so I didn't want to push it. I did great.

And in the case of my colonscopy, cut off of fluids is 4 hours before the procedure which I can live with. If I had been given an NPO after midnight, I would have questioned it.

49er

[49er]

And when your surgery is postponed for HOURS, (which happens way too often),
it becomes debilitating--especially when the patient is prone to hypoglycemia.

Wow, did they not give you anything in light of the ASA guidelines? That is outrageous.

I hope you raised a fuss about that.

[SewTired]

I don't know if it is because I'm diabetic or not, but they now give me NPO by HOURS before procedure instead of a blanket "nothing after midnight." For instance, no protein 8 hours before procedure, X amount of carbs allowed up to 4 hours before procedure, juice up to 2 hours (these are just examples).

Women in labor or having scheduled c-sections also are no longer starved at our local hospital because full-on anesthesia almost never happens and they can deal with the potential of aspiration (they do that all the time for car accident victims). Mothers and babies come out with better 'scores' when mom isn't starved.

[chunkyfrog]

49er, it was not me, but if it had been; yes, the venemous frog would have been spitting in somebody's eye.

[49er]

ST - I am glad to hear of your good experiences with NPO rules. It sounds like what you are being told to do is similar to the ASA guidelines which should apply to everyone.

CF - LOL! While I am not a frog:) I definitely on being assertive in situations that I feel call for it.