Preoperative NPO Guidelines for non-emergent surgery

For patients between 3 months and 104 years of age in whom there does not appear to be
reason for clinical concern about increased risk for aspiration, the following guidelines should be
observed in non-emergent ("elective) situations:
Until 8 hours prior to surgery:

Food and fluids ad lib

Until 6 hours prior to surgery:

Light meal* (e.g., toast and clear liquids), infant formula,

non-human milk.
Clear liquids only. No solids or foods containing fat in any
form, with the exception of breast milk for nursing infants.*
NPO for all solids and liquids.

Between 2 and 6 hours prior to surgery:

During the 2 hours prior to surgery:

*Infants may have breast milk until 4 hours prior to surgery.

Guidelines
1. Some examples of reasons for clinical concern regarding increased risk of aspiration
would be:
a.
b.
c.
d.
e.
f.

Obesity
Diabetes Mellitus with Gastroparesis
Pregnancy
A history of gastroesophageal reflux
Potential difficult airway management
Opiate analgesics

2. Some examples of what are acceptable as clear liquids, and what are not acceptable as
clear liquids would be:
a. Acceptable: Water, Sprite, Coffee or Tea (Without Milk or Lemon).
b. Not Acceptable: Orange Juice, Milk, Coffee or Tea with Milk, Infant Formula, any
beverage with alcohol.
3. For infants not at increased risk for aspiration of gastric contents, breast milk may be
ingested up to 4 hours prior to surgery.
NPO interval in non-emergent situations where there is clinical concern regarding increased
risk of aspiration is at least six to eight hours. The individual anesthesiologist should weigh
risks and benefits when determining the appropriate fasting interval in these situations.