NPO Status – No Correlation With Sedation Outcomes

June 13, 2018

Written by Clay Smith

Spoon Feed
In this cohort of thousands of pediatric ED sedation patients who didn’t meet the American Society of Anesthesiologists (ASA) fasting guideline, none had aspiration nor was there any correlation of fasting time with any adverse events or vomiting.  It is time to change hospital NPO policies for the ED.

Why does this matter?
Children often have procedures delayed due to NPO status in the ED, but the overwhelming evidence suggests that NPO status does not correlate with aspiration risk in PED procedural sedation, even in the anesthesia literature.  ACEP guidelines also do not recommend following fasting guidelines for ED sedation.  This gives even more evidence.

Sedation without hesitation
In 6183 children who underwent ED sedation, 48% did not meet ASA fasting guidelines for solid food; 5% for liquids.  Yet there were no aspiration events.  There was no association with fasting time and any adverse event, serious adverse event, or vomiting.  Ketamine was most commonly used agent, with 62.2% receiving ketamine alone; 20.7% received ketamine plus another agent (3.2% + midazolam; 13.7% + propofol; 3.8% + fentanyl). Most hospitals still follow ASA fasting guidelines for the ED, but more evidence accrues that ED patients are categorically different than OR patients when it comes to NPO status.  It is time for our hospital policies to reflect the evidence.

Source
Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children.  JAMA Pediatr. 2018 May 7. doi: 10.1001/jamapediatrics.2018.0830. [Epub ahead of print]

Another Spoonful
Justin Morgenstern’s, First 10EM masterful and comprehensive post on NPO for sedation is a must read.

Reviewed by Thomas Davis