Chapter 36: NPO Guidelines

INTRODUCTION

NPO means “nothing by mouth”, from the Latin nil per os. Our guidelines for food intake during labor have integrated the recommendations from the American Society of Anesthesiologists practice guidelines for obstetric anesthesia and the Society for Obstetric Anesthesia and Perinatology task force.^1–3

DURING LABOR WITH LABOR EPIDURAL

• Moderate amounts of clear liquids for uncomplicated laboring women. Clear liquids must be nonparticulate, e.g., water, carbonated beverages, sports drinks, fruit juices (no pulps), tea, and black coffee.

• Avoid milk, cream in the tea and coffee.

• Solid food should be avoided.

• Patients with increased risks for operative delivery have further restrictions on food intake.

ELECTIVE CESAREAN DELIVERY

• Last regular meal up to 8 hours prior.

• Light, low-fat snacks (e.g., crackers, one slice of dry toast) up to 6 hours prior.

• Clear liquids (carbonated, nonparticulate 45-g carbohydrate beverage) up to 2 hours prior.

• Patients with increased aspiration risks (morbid obesity, long-standing diabetes, difficult airway) may have further restrictions on food intake.

UNPLANNED CESAREAN DELIVERY

• NPO as soon as the decision for cesarean delivery is made.

• Depending on the urgency of delivery, anesthesia and obstetric team decide timing based on last intake.

• May utilize ultrasound to assess gastric content.

REFERENCES