Pre-Op & Post-Op Guidelines |
| Preop: NPO Guidelines |
| Preop EKG & CXR Guidelines (pdf) NEW |
| Preop LAB Guidelines (pdf) NEW |
| Preop Suboxone Instructions (pdf) NEW |
| Postop: Guidelines for Phase II Recovery ASU ("Fastrack") |
|
A. ASA NPO GuidelinesB. Maine Med Center NPO Instructions to Patients |
ASA NPO Guidelines, 1998
Summary of Fasting Recommendations to Reduce the Risk of Pulmonary
Aspiration
NPO Guidelines, 1998 (ASA) (1)
Ingested
Material:
Minimum
Fast(2):
Clear
liquids (3)
2
h
Breast
milk
4
h
Infant formula
6
h
Non-human
milk (4)
6
h
Light
meal (5)
6
h
Footnotes (hyperlinked):
1 These recommendations apply to
healthy patients
who are undergoing elective procedures. They are not intended
for women in labor. Following the guidelines does not guarantee
a complete gastric emptying has occurred.
2 The fasting periods noted above
apply to all ages.
3 Examples of clear liquids include water, fruit
juices without pulp, carbonated beverages, clear tea, and black
coffee.
4 Since non-human milk is similar to solids in
gastric emptying time, the amount ingested must be considered
when determining an appropriate fasting period.
5 A light meal typically consists of toast and
clear liquids. Meals that include fried or fatty foods or meat
may prolong gastric emptying time. Both the amount and type of
foods ingested must be considered when determining an appropriate
fasting period.
There is NO recommendation for
ROUTINE use of:
a. gastrointestinal stimulants (metoclopramide)
b. Gastric acid secretion blockers (H2 blockers)
c. Antacids (bicarb, Na citrate)
d. Antiemetics (ondansetron)
e. Anticholinergics (atropine, glycopyrrolate)
f. Combinations of the above.
These
NPO guidelines are somewhat more restrictive, to allow for changes in
the surgical schedule, etc. These are the instructions given to
patients on the Preoperative Visit or phone call.
Under 1 year:
1. No food, milk, breast milk, or formula 6 hours before surgery.
2. Encourage apple juice, water, white grape juice, or Pedialyte up to 2 hours before surgery.
3. NPO for the 2 hours before surgery.
Over 1 year, including adults:
1. No food or milk after midnight, regardless of time of surgery.
2. Coffee (without cream or milk), apple juice, cranberry juice, water, or other clear liquid up to 4 hours prior to surgery.
3. NPO for the 4 hours prior to surgery.
ADMISSION CRITERIA GUIDELINES FOR PHASE II RECOVERY
(ASU)
"Fastrack"
October 2003
| Parameter | Criteria |
| Neurological | Return to pre-procedure level of consciousness. Arouses easily to voice, answers questions, able to follow commands. |
| Neurovascular | Return to pre-procedure level of motor/sensory function (i.e. moving all extremities; regional blocks to extremities excepted) |
| Respiratory | Patient maintains patent airway. Patient maintains respiratory rate > 10 breaths/minute. Patient able to deep breathe and cough. Patient maintains oxygen saturation >91% on room air or on 2-4 lpm O2 via nasal cannula. |
| Cardiovascular | Patient's systolic blood pressure is within 20mm Hg of pre-procedural
level. Patient's heart rate and EKG rhythm is within patient's baseline Patient's temperature is > 36° or at pre-procedural baseline. |
| Pain | Pain level 3 on Verbal Analog Scale (VAS) or small amount by description; should not require aggressive pain management |
| Surgical Dressing | Patient has no significant bleeding or amount of drainage is appropriate to procedure. |
| Age | Children < 10 years not accepted for direct admission to Phase II (1:1 Nursing observation not available)
|