1.
NPO Means “Nothing by Mouth”
NPO means “nothing by mouth,” from the Latin nil per os. The acronym is simply
a doctor’s shorthand for a period of time in which you may not eat or drink anything
(ask about prescription medication).
Fasting is generally prescribed in preparation for an operation or exam. In medical
imaging, doctors usually order it for CT scans that use iodine-based
intravenous contrast or for exams that use sedation.
2. NPO is a Safety Precaution
NPO is usually prescribed as a safety precaution. Without it, you could become
nauseous once contrast or sedation is administered because you have something in
your stomach. This can lead to aspiration meaning you might uptake your
stomach contents into your lungs. Aspiration can lead to pneumonia and other
health issues.
To avoid potential safety concerns, abstaining from eating or drinking is
recommended for children and adults receiving certain kinds of sedation or contrast.
3. The Length of Time Varies
For some exams and procedures, nil per os starts an hour before the exam. For
others it can start as early as midnight the night before the exam. You will
receive special instructions for NPO based on the exam you are having.
“2-4-6-8 rule”
Pre-operative fasting standards have been developed by anesthesia societies with
almost all following a variant of the “2-4-6-8 rule”. The American Society of
Anesthesiologists (ASA) recommends patients to fast from fatty food or meats eight
(8) hours prior to surgery, non-human milk or light meal for six (6) hours prior, breast
milk for four (4) hours prior, and clear liquids including water, pulp-free juice, and tea
or coffee without milk for two (2) hours prior to the anesthetic.
Post-operative Care
We normally require that our patients ambulate within 12 hours of surgery. Therefore we
have to take great care of two things:
Nutrition
Fluid and Electrolyte Management
Nutrition
Regular diet should be given to the patient as soon as the patient’s condition
permits.
Chronic illness: chronically ill individual undergoing extensive surgery, early
postoperative nutritional supplementation is essential for timely wound healing and
immunological defense.
Acute illness: If allowed to eat within one week, these patients will generally do well.
Gastrointestinal dysmotility
Patients with gastrointestinal dysmotility should be initially kept NPO for 48 hours or
until symptoms of nausea resolve. For those who are: severely symptomatic with
continued vomiting and distention, a nasogastric tube should be inserted and placed on
suction. As gastric motility returns, noted by decreased NG output and resolution of
nausea, the tube can be removed and the patient advanced to a clear liquid diet. Prior
to oral advancement, the patient should receive at least 100 grams of glucose in the
form of 2 liters of 5% dextrose per day; this will minimize protein catabolism during
this starvation period.
Routes for the administration of food
Enteral feeding: nasal feeding tube or surgically placed feeding jejunostomy
Central venous catheter is utilized if the enteral route cannot be used to maintain
adequate nitrogen balance.
Fluid and electrolyte Balance
Postoperative fluid management is dependent on:
Current deficits
Maintenance requirements
Abnormal losses
Current Deficit
The status of the patient's current conditions should first be determined. Utilizing
information from the patient's history such as preoperative vomiting,
Bowel distention,
Oral intake,
Intraoperative hemorrhage,
Extravascular fluid accumulation (third space),
Previous fluid replacement,
Physical examination,
Vital signs,
Recent weight change,
Record of fluid balance can also help to determine the status of the intravascular
volume and total body water.
Maintenance Requirements
Daily maintenance requirement for water is calculated to replace insensible losses, a
daily maintenance requirement between 35–40 ml/kg/day is necessary.
Abnormal Losses
Abnormal losses can be estimated by the addition of NG tube output, fistula tract
drainage, and sump suction discharge. Quantitation of the drainage tubes is easily
performed.
References:
1. ASA. 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.
Anesthesiology 126, 376-393, doi:10.1097/aln.0000000000001452 (2017).
2. Rosen, D., Gamble, J. & Matava, C. Canadian Pediatric Anesthesia Society
statement on clear fluid fasting for elective pediatric anesthesia. Canadian journal
of anaesthesia = Journal canadien d’anesthesie 66, 991-992,
doi:10.1007/s12630-019-01382-z (2019).
3. Virgilio RW, Smith DE, Zarims CK: Balanced electrolyte solutions: Experimental and clinical
studies. Crit Care Med 7: 98, 1979
