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What are the nil per os (NPO) guidelines for this case?
There is a lot of variation among institutions regarding NPO policies for clears, formula, breast milk, and solids. Even among pediatric anesthesiologists, there is disagree-ment. The American Academy of Pediatrics and American Society of Anesthesiologists formed a task force, which made the following recommendations regarding NPO for various liquids and food:
· 2 hours for clear liquids
· 4 hours for breast milk
· 6 hours for non-human milk or a light meal
· 8 hours for fatty solid meals
The task force describes a light meal as tea and toast. The recommendation of 6 hours for non-human milk comes with the caveat that the amount of milk the patient drank may affect the amount of time necessary for complete emptying of the stomach. In other words, a longer time than 6 hours may be necessary to assure complete empty-ing of the stomach.
These recommendations apply to patients not consid-ered “full stomachs.” One must still use appropriate judg-ment in patients who have certain underlying medical conditions (gastroesophageal reflux) or who are presenting for emergency surgery. Pharmacologic agents used to increase gastric emptying and reduce gastric acidity should be considered in certain cases.
In general, NPO policies have been liberalized recently because longer fasting times were found to be unnecessary. Patients were becoming unnecessarily dehydrated. In the pediatric population, this also led to irritability, and in the very young neonate, possibly hypoglycemia. Prolonged fasting times also caused unnecessary distress to the child and the parents. Whatever policy you choose, it should be clearly communicated to the parents and the operating room staff to prevent unnecessary prolonged fasting times.
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