[size=20px]A 3-month-old infant is scheduled to have an elective inguinal hernia repair at 0730. The preoperative nurse calls you concerned that the parents gave the baby Pedialyte at 0500 before they left home as the baby was crying. The baby consumed 5 oz of formula at 2300 the night before. What time should you perform the procedure?

 

A 0730

 

B 0900

 

C 1100

 

D 1300

 

E Reschedule for another day[/size]

A.

pedialyte is a rehyrating liqiud. There is no fear of regurgitation or vomiting during anesthesia as that fluid will not stay in the stomach

A

A

A

correct answer

A 0730

 

Despite the fact that the ASA Committee on Standards and Parameters for preoperative fasting has been published since 2011, the order “NPO after midnight” continues to permeate practice. In the current guidelines, clear liquids may be ingested up to 2 hours prior to the scheduled procedure. Recent guidelines published by Frykhholm et al. actually shortened the recommended time to 1 hour, but this practice is not yet well accepted in the US.

 

The main concern is the risk for aspiration if undergoing sedation or anesthesia on a full stomach. However, the risk of aspiration after clear liquid ingestion before going to the OR is 0.03%. Furthermore, these aspiration episodes did not cause significant morbidity (such as ICU care) or mortality.

 

Conditions that have been identified to be associated with a higher likelihood of aspiration include airway manipulation, intestinal obstruction and esophageal disorders (such as achalasia).

 

The following factors do not increase aspiration risk: lower gastric pH, shorter fasting times or gum chewing.