Remove Cheeseburger, Push Sedation

NPO status did not predict aspiration or other complication in this large pediatric sedation cohort. Delay sedation only if the patient has a cheeseburger in their mouth. Remove the burger, and push drugs.

Anesthesiology. 2016 Jan;124(1):80-8. doi: 10.1097/ALN.0000000000000933.

Major Adverse Events and Relationship to Nil per Os Status in Pediatric Sedation/Anesthesia Outside the Operating Room: A Report of the Pediatric Sedation Research Consortium.

Beach ML1, Cohen DM, Gallagher SM, Cravero JP.

Author information:

1From the Departments of Anesthesiology and Pediatrics (M.L.B.) and Department of Biomedical Data Science (M.L.B., S.M.G.), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio (D.M.C.); and Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts (J.P.C.).



Studies that have attempted to define the incidence of aspiration or pulmonary complications during sedation/anesthesia of children with respect to nil per os (NPO) status or other factors are difficult because of the relatively infrequent rate of these complications.


The Pediatric Sedation Research Consortium consists of 42 participating institutions with elective sedation services that submit consecutive patient encounter information to a central database. The authors evaluated aspiration episodes and a combined outcome of major adverse events (defined as aspiration, death, cardiac arrest, or unplanned hospital admission) with respect to NPO status, American Society of Anesthesiologists physical status, age, propofol use, procedure types, and urgency of the procedure.


A total of 139,142 procedural sedation/anesthesia encounters were collected between September 2, 2007 and November 9, 2011. There were 0 deaths, 10 aspirations, and 75 major complications. NPO status was known for 107,947 patients, of whom 25,401 (23.5 %) were not NPO. Aspiration occurred in 8 of 82,546 (0.97 events per 10,000) versus 2 of 25,401 (0.79 events per 10,000) patients who were NPO and not NPO, respectively (odds ratio, 0.81; 95% CI, 0.08 to 4.08; P = 0.79). Major complications occurred in 46 of 82,546 (5.57 events per 10,000) versus 15 of 25,401 (5.91 events per 10,000) (odds ratio, 1.06; 95% CI, 0.55 to 1.93; P = 0.88). Multivariate adjustment did not appreciably impact the effect of NPO status.


The analysis suggests that aspiration is uncommon. NPO status for liquids and solids is not an independent predictor of major complications or aspiration in this sedation/anesthesia data set.

PMID: 26551974 [PubMed - in process]

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