He's not the only one facing the major stress of surgery while hun-
gry, thirsty, anxious, nauseated and generally uncomfortable. Surgical
facility leaders across the nation are generally slow to abandon out-
dated pre-op fasting policies, according to last month's Outpatient
Surgery Magazine online survey of 153 surgical facility leaders.
• NPO by midnight. More than half (54.8%) of our survey respondents
still follow the overly rigid fasting instructions of NPO-by-midnight
totally or in some form. "No one will die from not eating for one
morning," says Brett Swain, RN, an OR nurse at the Alta Bates
Summit Medical Center in Oakland, Calif. "People who aspirate are at
markedly higher risk of pneumonia and death. It isn't worth the risk-
benefit ratio. You don't know the entire picture of the patient. Is he on
narcotics that will slow gastric emptying? Is he borderline diabetic but
not on meds yet?"
• Clear liquids. Even though decades of research support the safety
and health benefits of consuming clear liquids until a few hours
before surgery, surgical facility leaders routinely instruct patients to
fast for excessively long pre-op periods. Only about one-third (31.1%)
of our survey respondents tell patients they can drink 2 hours before
their procedures, while 43% instruct patients not to drink anything
after midnight.
When the American Society of Anesthesiologists published its first
practice guidelines for pre-operative fasting for healthy patients
undergoing elective surgical procedures 17 years ago, it declared it
safe for such patients to "have clear liquids up to 2 hours prior to
surgery."
"We give our patients a specific time to stop clear liquids. Generally
it is 2 to 2
1
⁄2 hours before their arrival at our center," says the director
of an ENT surgery center. "If the patient is to arrive at 0830, we would
tell her to stop the clear liquids at 0600. It works out to be about 3
5 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 6
