bob’s bet copyright © 2014, all rights reserved from the publishers of
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Bob’s Bet
COPYRIGHT © 2014, ALL RIGHTS RESERVED
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Dear Consult Guys;
We were hanging out in the preadmission testing
center the other day when a woman was being
given instructions prior to colonoscopy to be done
next week under general anesthesia.
Her procedure was to be done in the afternoon and
she was told not to have anything to eat or drink
from midnight the night before. I thought that our
policy was incorrect and that she could undergo
general anesthesia 4-6 hours after clear liquids.
One of the other guys said that general anesthesia
is safe when done after only a 2 hour fast following
clear liquids.
Is our policy incorrect based on the evidence?
Dear Consult Guys;
We were hanging out in the preadmission testing
center the other day when a woman was being
given instructions prior to colonoscopy to be done
next week under general anesthesia.
Her procedure was to be done in the afternoon and
she was told not to have anything to eat or drink
from midnight the night before. I thought that our
policy was incorrect and that she could undergo
general anesthesia 4-6 hours after clear liquids.
One of the other guys said that general anesthesia
is safe when done after only a 2 hour fast following
clear liquids.
Is our policy incorrect based on the evidence?
Copyright © 2014
Fast from midnight (“NPO after midnight”)
Six hour fast
Four hour fast
Two hour fast
NPO (non-nil per os)
Copyright © 2014
Hint for Audience
“While it is desirable that there be no solid matter in the stomach when chloroform is administered, it will be found very salutary to give a cup of tea or beef-tea about two hours previously.”
Lord Joseph Lister, 1882
Copyright © 2014
1946: Mendelson. High incidence of pulmonary aspiration among OB patients receiving general anesthesiaAnimal data: lung injury related to
volume of aspirate and decreased pH
Recent data: Pulmonary aspiration rare.
Fasting can lead to dehydration, hypovolemia, hypoglycemia
Key Points
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Copyright © 2014
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration (Am Soc of Anesthesiologists, 1999)
Pulmonary aspiration is rareLittle relation between fasting duration
and gastric volume or pHProlonged fasting may have adverse
effectsLiquids and solids are eliminated
differently from the stomach
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Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration (Am Soc of Anesthesiologists, 2010)
Minimum preoperative fasting for healthy people Clear liquids – two hours
Water, fruit juice without pulp, clear tea, black coffee
Light meal (toast + liquid) – six hours Regular meal (fried or fatty food) – eight
hours
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Consult Guys Replies
Clear liquids safe up to two hours before general anesthesia
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