Department of Anesthesiology, Loyola University Medical Center, Maywood, IL, USA -
Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
Minerva Anestesiol. 2018 Dec;84(12):1413-1419. doi: 10.23736/S0375-9393.18.13042-2. Epub 2018 Oct 30.
Preoperative nil per os (NPO) guidelines have been in existence since the recognition of the risk of perioperative aspiration. These guidelines aim at reducing the risk for gastric content aspiration to the lowest possible, to avoid associated morbidity, unplanned hospital and/or an intensive care admission. Thus, such guidelines are not only considered for patients having major surgeries, but more so in those having ambulatory surgery including those performed at non-operating room anesthesia locations. NPO guidelines have always been controversial due to the paucity of data in support of one recommendation versus another and have seen multiple changes and updates by the issuing national anesthesiology societies as new evidence emerges. At the present time, they have become increasingly permissive, such that the ingestion of clear fluids is now encouraged up to two hours before elective surgery. This has added more fuel to the already heated controversies regarding NPO guidelines and contributed to the experienced variability among different local NPO policies adopted by different clinicians. In this article, we attempt to discuss many of these controversies, including the relationship between NPO duration and the risk of aspiration, NPO and the choice of airway device, NPO and operating room efficiency and NPO for procedural sedation.
术前禁食（NPO）指南自认识到围手术期吸入风险以来就已存在。这些指南旨在将胃内容物吸入的风险降到最低，以避免相关发病率、非计划住院和/或入住重症监护病房。因此，这些指南不仅适用于接受大手术的患者，而且更适用于接受门诊手术的患者，包括在非手术麻醉场所进行的手术。由于缺乏支持一种建议而不是另一种建议的数据，NPO 指南一直存在争议，并随着新证据的出现，发布国家麻醉学会多次进行更改和更新。目前，它们变得越来越宽松，以至于现在鼓励在择期手术前两小时内饮用清澈的液体。这给 NPO 指南已经激烈的争议增添了更多的争议，并导致不同临床医生采用的不同当地 NPO 政策之间存在经验性差异。在本文中，我们试图讨论其中的许多争议，包括 NPO 持续时间与吸入风险之间的关系、NPO 和气道装置的选择、NPO 和手术室效率以及 NPO 用于程序镇静。
