Pro/Con
Nil Per Os, What Guideline’s Should We Follow…?
By Nicole Dobija, MD
Mott Children’s Hospital
University of Michigan
Ann Arbor, MI
There is much debate as to what a normal fasting time should be for a healthy child undergoing an elective procedure. The ANZCA (Australia and New Zealand College of Anesthetists) have NPO guidelines for children older than six months of age that include clear fluids up until one hour prior to procedure and for infants under six months of age undergoing an elective procedure, formula may be given up to four hours prior, breast milk up to three hours, and clear fluids up to one hour prior to anesthesia (1).
The American Society of Anesthesiologists recommends guidelines for fasting times of clear liquids of two hours, breast milk for four hours and formula or a light meal for at least six hours prior to planned procedure in healthy children (2).
What about the intubated patient who is receiving post pyloric feeds? While there may be a planned or elective procedure scheduled, most children who are intubated and receiving post-pyloric feeds are critically ill. Many of these children will undergo radiological studies and surgical procedures. What is the right amount of time that they should be NPO or should they NOT be made NPO for their procedure?
Most pediatric practices have adopted less stringent NPO guidelines for burn patient’s due to their high metabolic demand. What about the intubated patient receiving post-pyloric feeds who needs to have an external fixator placed for their tibial plateau fracture? Should their enteral tube feeds be stopped and if yes, for how long? In the following debate, Dr. Colletti will present why we should observe standard conventional NPO times for these patients. Drs. Elliot, Isserman and Fiadjoe will present arguments as to why we should continue feeds in this patient population.
The following discussion should give thought as to how we move forward and provide the optimal care for these patients and what future research needs to be done in this area.
- http://www.anzca.edu.au/patients/what-to-expect
- American Society of Anesthesiologists: Practice guidelines for pre-operative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures–a report by the American Society of Anesthesiologists Task Force on Preoperative Fasting. Anesthesiology 2017; 126:376-93
If you have an idea for a controversial or pro-con debate please email your idea to Nicole Dobija at ndobija@med.umich.edu.
