Nothing by mouth

Last updated

Nothing by mouth is an American medical instruction meaning to withhold food and fluids. It is also known as nil per os (npo or NPO), a Latin phrase that translates to English as "nothing through the mouth". Nil by mouth is the term used in the UK (NBM), nihil/non/nulla per os, or complete bowel rest. [1] A liquid-only diet may also be referred to as bowel rest. [2]

Contents

NPO is one of the abbreviations that is not used in AMA style; "nothing by mouth" is spelled out instead.

Purpose

The typical reason for NPO instructions is the prevention of aspiration pneumonia, e.g. in those who will undergo general anesthesia, or those with weak swallowing musculature, or in case of gastrointestinal bleeding, gastrointestinal blockage, or acute pancreatitis. Alcohol overdoses that result in vomiting or severe external bleeding also warrant NPO instructions for a period.

Duration

Pre-surgery NPO orders are typically between 6 and 12 hours prior to surgery, through recovery suite discharge, but may be longer if long acting medications or oral post-meds were administered. It is not uncommon for the food NPO period to be longer than that for liquid, as the American Board of Anesthesiology advises against liquid NPO periods greater than eight hours.[ citation needed ] The NPO periods for illness tend to be much longer, although exceptions are made for small scheduled amounts of water consumption if an IV drip is not in use. With sufficient IV fluids, NPO periods of several days have been utilized successfully in non-diabetic patients (although short NPO periods in diabetics are possible with IV fluids, insulin, and dextrose.[ citation needed ] Extended periods (greater than 12 hours) are still contraindicated).

The American Board of Anesthesiology recommends that patients should not eat solid food for at least 8 hours prior to a procedure, and should not drink even clear liquids for at least 2 hours prior. [3] Clear liquid fasting includes water, juices without pulp, carbonated beverages, clear tea, and black coffee. [4] Ingestion of water 2 hours prior to a procedure results in smaller gastric volumes and higher gastric pH when compared with those who ingested > 4 hours prior. The volume of liquid is less important than the type of liquid ingested. [4] Non-emergency surgical cases should be delayed for NPO status.

When nothing by mouth or a liquid-only diet is indicated for an extended period, enteral feeding or total parenteral nutrition may be recommended.

Unrestricted clear fluids

Fasting guidelines often restrict the intake of any oral fluid after two to six hours preoperatively. However, it has been demonstrated in a large retrospective analysis in Torbay Hospital that unrestricted clear oral fluids right up until transfer to theatre could significantly reduce the incidence of postoperative nausea and vomiting without an increased risk in the adverse outcomes for which such conservative guidance exists. [5]

See also

Related Research Articles

<span class="mw-page-title-main">Antacid</span> Substance that relieves stomach problems

An antacid is a substance which neutralizes stomach acidity and is used to relieve heartburn, indigestion, or an upset stomach. Some antacids have been used in the treatment of constipation and diarrhea. Marketed antacids contain salts of aluminum, calcium, magnesium, or sodium. Some preparations contain a combination of two salts, such as magnesium carbonate and aluminum hydroxide.

<span class="mw-page-title-main">General anaesthesia</span> Medically induced loss of consciousness

General anaesthesia (UK) or general anesthesia (US) is a method of medically inducing loss of consciousness that renders a patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients. Depending on the procedure, general anaesthesia may be optional or required. Regardless of whether a patient may prefer to be unconscious or not, certain pain stimuli could result in involuntary responses from the patient that may make an operation extremely difficult. Thus, for many procedures, general anaesthesia is required from a practical perspective.

<span class="mw-page-title-main">Esophagogastroduodenoscopy</span> Diagnostic endoscopic procedure

Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure. However, a sore throat is common.

Postoperative nausea and vomiting (PONV) is the phenomenon of nausea, vomiting, or retching experienced by a patient in the post-anesthesia care unit (PACU) or within 24 hours following a surgical procedure. PONV affects about 10% of the population undergoing general anaesthesia each year. PONV can be unpleasant and lead to a delay in mobilization and food, fluid, and medication intake following surgery.

<span class="mw-page-title-main">Bethanechol</span> Chemical compound

Bethanechol is a parasympathomimetic choline carbamate that selectively stimulates muscarinic receptors without any effect on nicotinic receptors. Unlike acetylcholine, bethanechol is not hydrolyzed by cholinesterase and will therefore have a long duration of action. Bethanechol is sold under the brand names Duvoid (Roberts), Myotonachol (Glenwood), Urecholine, and Urocarb (Hamilton). The name bethanechol refers to its structure as the urethane of beta-methylcholine.

<span class="mw-page-title-main">Gastric bypass surgery</span> Type of bariatric surgery

Gastric bypass surgery refers to a technique in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different gastric bypass procedures (GBP). Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and physical response to food.

<span class="mw-page-title-main">Ileus</span> Medical condition

Ileus is a disruption of the normal propulsive ability of the intestine. It can be caused by lack of peristalsis or by mechanical obstruction. The word 'ileus' is from Ancient Greek eileós. The term 'subileus' refers to a partial obstruction.

<span class="mw-page-title-main">Dumping syndrome</span> Medical condition

Dumping syndrome occurs when food, especially sugar, moves too quickly from the stomach to the duodenum—the first part of the small intestine—in the upper gastrointestinal (GI) tract. This condition is also called rapid gastric emptying. It is mostly associated with conditions following gastric or esophageal surgery, though it can also arise secondary to diabetes or to the use of certain medications; it is caused by an absent or insufficiently functioning pyloric sphincter, the valve between the stomach and the duodenum.

Colic in horses is defined as abdominal pain, but it is a clinical symptom rather than a diagnosis. The term colic can encompass all forms of gastrointestinal conditions which cause pain as well as other causes of abdominal pain not involving the gastrointestinal tract. What makes it tricky is that different causes can manifest with similar signs of distress in the animal. Recognizing and understanding these signs is pivotal, as timely action can spell the difference between a brief moment of discomfort and a life-threatening situation. The most common forms of colic are gastrointestinal in nature and are most often related to colonic disturbance. There are a variety of different causes of colic, some of which can prove fatal without surgical intervention. Colic surgery is usually an expensive procedure as it is major abdominal surgery, often with intensive aftercare. Among domesticated horses, colic is the leading cause of premature death. The incidence of colic in the general horse population has been estimated between 4 and 10 percent over the course of the average lifespan. Clinical signs of colic generally require treatment by a veterinarian. The conditions that cause colic can become life-threatening in a short period of time.

Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach using a tube. Since its first recorded use in early 19th century, it has become one of the most routine means of eliminating poisons from the stomach. Such devices are normally used on a person who has ingested a poison or overdosed on a drug such as ethanol. They may also be used before surgery, to clear the contents of the digestive tract before it is opened.

<span class="mw-page-title-main">Gastrointestinal perforation</span> Medical condition

Gastrointestinal perforation, also known as gastrointestinal rupture, is a hole in the wall of the gastrointestinal tract. The gastrointestinal tract is composed of hollow digestive organs leading from the mouth to the anus. Symptoms of gastrointestinal perforation commonly include severe abdominal pain, nausea, and vomiting. Complications include a painful inflammation of the inner lining of the abdominal wall and sepsis.

<span class="mw-page-title-main">Whole bowel irrigation</span> Medical process

Whole bowel irrigation (WBI) is a medical process involving the rapid administration of large volumes of an osmotically balanced macrogol solution, either orally or via a nasogastric tube, to flush out the entire gastrointestinal tract.

<span class="mw-page-title-main">Vomiting</span> Involuntary, forceful expulsion of stomach contents, typically via the mouth

Vomiting is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.

<span class="mw-page-title-main">Barium sulfate suspension</span> Contrast agent used during X-rays

Barium sulfate suspension, often simply called barium, is a contrast agent used during X-rays. Specifically it is used to improve visualization of the gastrointestinal tract on plain X-ray or computed tomography. It is taken by mouth or used rectally.

<span class="mw-page-title-main">Gastroparesis</span> Medical condition

Gastroparesis, also called delayed gastric emptying is a medical disorder consisting of weak muscular contractions (peristalsis) of the stomach, resulting in food and liquid remaining in the stomach for a prolonged period of time. Stomach contents thus exit more slowly into the duodenum of the digestive tract. This can result in irregular absorption of nutrients, inadequate nutrition, and poor glycemic control. The opposite of this, where stomach contents exit quickly into the duodenum is called dumping syndrome.

Minimally invasive thoracic spinal fusion is one of the approaches to scoliosis surgery. Instead of a vertical scar down the back or horizontal from the middle of the chest to the center of the back, a rod is inserted through a series of small incisions on the side of the body. The spine is not exposed during the surgery; a small scope is used instead.

<span class="mw-page-title-main">Nausea</span> Medical symptom or condition

Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.

Preoperative fasting is the practice of a surgical patient abstaining from eating or drinking for some time before having an operation. This is intended to prevent stomach contents from getting into the windpipe and lungs while the patient is under general anesthesia. The latest guidelines do not support preoperative fasting, as there is no difference in residual gastric fluid volume, pH or gastric emptying rate following semi-solid meals or drinks, whether in obese or lean individuals.

<span class="mw-page-title-main">Oral administration</span> Route of administration where a substance is taken through the mouth

Oral administration is a route of administration whereby a substance is taken through the mouth, swallowed, and then processed via the digestive system. This is a common route of administration for many medications.

<span class="mw-page-title-main">Cancer and nausea</span>

Cancer and nausea are associated in about fifty percent of people affected by cancer. This may be as a result of the cancer itself, or as an effect of the treatment such as chemotherapy, radiation therapy, or other medication such as opiates used for pain relief. About 70 to 80% of people undergoing chemotherapy experience nausea or vomiting. Nausea and vomiting may also occur in people not receiving treatment, often as a result of the disease involving the gastrointestinal tract, electrolyte imbalance, or as a result of anxiety. Nausea and vomiting may be experienced as the most unpleasant side effects of cytotoxic drugs and may result in patients delaying or refusing further radiotherapy or chemotherapy.

References

  1. Hanauer, Theodore M.; Bayless, Stephen B (2011). Advanced therapy of inflammatory bowel disease (Third ed.). p. 756. ISBN   9781607952176.
  2. Nutrition Essentials and Diet Therapy. Elsevier Health Sciences. 2013. p. 175. ISBN   9780323266932.
  3. Apfelbaum, Jeffrey; Caplan, Robert; Connis, Richard; Epstein, Burton; Nickinovich, David; Mark, Warner (March 2011). "Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures" (PDF). Anesthesiology . 114 (3): 498–499. Retrieved 4 January 2016.
  4. 1 2 Levy, DM. Pre-operative fasting – 60 years on from Mendelson. Contin Educ Anaesth Crit Care Pain (2006) 6 (6): 215-218
  5. McCracken, Graham C.; Montgomery, Jane (2017-11-06). "Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: A retrospective analysis". European Journal of Anaesthesiology (5): 337–342. doi:10.1097/EJA.0000000000000760. ISSN   0265-0215. PMID   29232253. S2CID   4486702.