NPO Guidelines

This is Todd Ponsky from the Journal of Pediatric Surgery. Last week we had a course in Akron, and this week I'm out camping, but the show must go on. So here's your two minute review. Today we're gonna review an article called Surgical Fasting Guidelines in Children. Are we putting them into practice? The first author is Doctor Kim Burnett Wood, and the senior author is Doctor Bodil Larson from the University of Alberta. This is a low powered study, but it hits on a very important point, this new concept of minimizing NPO time both pre and postoperatively. The guidelines have been clearly defined that 2 hours before surgery, a child can have clear liquids, 4 hours before surgery they can have breast milk, 6 hours before surgery they can have non-human milk such as cow's milk, and 8 hours before surgery they can have food or solids. It's been shown that if you allow children to drink up to 2 hours before surgery, especially a carbohydrate drink, they'll be better hydrated and not hypoglycemic, which has been shown to decrease complications and decrease length of stay. So what they did in this study is they looked prospectively at 53 patients to see what percentage of them actually adhered to these guidelines, and they found that 70% of the patients were NPO longer than needed to be. And in fact, even postoperatively, even if the orders were written for the patient to have a diet, they were NPO after surgery. Complex cases had longer postoperative NPO times even though the guidelines state that any operation should be having immediate or early feedings after surgery. So this was a very good study. I really like the fact that this is highlighting this new concept that most of us are not in tune to yet, this idea of letting the children drink right up to surgery, 2 hours before surgery, a carbohydrate drink, and letting them feed immediately postoperatively. We hope you enjoyed this review. We'll see you next time. Thanks.