Pre-Op NPO Guidelines in the Adult Patient

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The following table summarizes the guidelines for preoperative fasting. Several caveats are listed in the “notes” section. See Burn section for NPO guidelines on burn patients.

 

Table 1. Summary of preoperative fasting recommendations to reduce the risk of pulmonary aspiration in adult patients.

Ingested Material	Minimum Fasting Period2
Clear liquids 3	2 h
Non-clear Liquids & Solids 5	6 h

Notes:

1. These recommendations apply to healthy patients who are undergoing elective procedures. They are not intended for women in labor. Following the guidelines does not guarantee complete gastric emptying has occurred.
2. The fasting periods noted above apply to all adult ages.
3. Examples of clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. 1-2 glucose tablets is considered NPO Continue to advise not to chew gum or suck on hard candy for 6hrs prior to procedure. If, on day of surgery, patient is chewing gum or sucking on hard candy, they should be required to spit it out - there is no need to delay the procedure if they comply. Miralax, which is polyethylene glycol or PEG 3350, completely dissolves and leaves no particulate matter. Consider Miralax as a clear fluid.
4. Since non-human milk is similar to solids in gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period.
5. The policy pertaining to “solids” is applicable to any quantity of solid food. Best is a light meal typically consisting of toast and clear liquids. Meals that include fried or fatty foods or meat may prolong gastric emptying time. Both the amount and type of foods ingested must be considered when determining an appropriate fasting period.
6. Medications can be taken the morning of the procedure with up to 60 cc’s of water. See Burn Section for Adult & Pediatric Burn patients.