Anesthesia Can’t Let NPO Go

Short Attention Span Summary

It helps to know other specialist’s literature
Although fasting doesn’t appear to be of benefit for ED procedural sedation, it’s important to know what our anesthesia colleagues are thinking.  Interestingly, despite pediatric anesthesia literature finding NPO status doesn’t apply to procedural sedation in almost 140,000 patients, this guideline still lumps it in with general anesthesia in the NPO recommendations below.  Here is the anesthesia bible on the subject.

• Do a H&P; determine ASA status; ask about reflux, motility issues, and diabetes, which all impact risk of aspiration.  This is a good idea for us in the ED too.  Know the patient you’re about to sedate.
• Clear liquids are OK up to 2 hours prior…obviously, not applicable to the ED.
• Breast milk up to 4 hours prior
• Infant formula up to 6 hours prior
• Solids up to 6 hours prior; longer if fried, fatty, or meat. Sorry, Kentucky Fried Chicken fans.
• GI stimulants, antiemetics, or antacids don’t routinely have a role but may be used in those at risk for aspiration (not in the ED); anticholinergics have no role for aspiration prevention in anesthesia (or the ED).

Spoon Feed
It’s helpful to know what your anesthesia colleagues are thinking when you admit patients who need a trip to the OR.  Some of this is not applicable to ED procedural sedation, but there are a few pearls for us in this guideline.

Abstract

Anesthesiology. 2017 Mar;126(3):376-393. doi: 10.1097/ALN.0000000000001452.

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: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration.

PMID: 28045707