Schmidt Alexander R, Fehr James, Man Janice, D'Souza Genevieve, Wang Ellen, Claure Rebecca, Mendoza Julianne
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Anesth Pain Med (Seoul). 2021 Jul;16(3):266-272. doi: 10.17085/apm.21025. Epub 2021 Jul 21.
The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force.
Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient's arrival time (90 min before operating room [OR] time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range).
9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30).
This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time.
术前禁食的目的是防止全身麻醉期间发生肺误吸。禁食时间常常延长，导致患者不适及不良事件风险。这项回顾性质量改进调查评估了有效的禁水禁食（NPO）时间以及NPO时间延长的原因，旨在由一个新成立的禁食特别工作组提出改进策略。
回顾了我院2019年所有电子麻醉记录中的禁食时间。我们的NPO指南遵循美国麻醉医师协会的指导原则，并根据患者到达时间（手术间[OR]时间前90分钟）计算。主要结局是清亮液体的有效NPO时间，次要结局是延迟发生率及家长对NPO指南的依从性。数据以中位数（四分位间距）表示。
9625例纳入分析。72.1%记录了NPO时间，有效NPO时间中位数为7:13小时（7:36）。72.8%记录了进入手术间时间，2075例（29.5%；中位数时间0:10小时[0:21]）早于预定时间，4939例（70.5%；中位数时间0:29小时[0:54]）晚于预定时间。家长NPO依从性显示清亮液体摄入的中位数偏差为0:55小时（8:30）。
本研究显示，有效的NPO时间长于当前美国麻醉医师协会指南。促成因素包括病例延迟及家长未遵守NPO指南。因此，特别工作组的建议包括将NPO指南计算改为预定的OR时间而非到达时间，并鼓励家长在规定时间给孩子喂清亮液体。
