Correspondence  |   August 2016
Is It Time to Ask Different Questions about Aspiration?
Author Notes
  • Vanderbilt University, Monroe Carrell Jr. Children’s Hospital, Nashville, Tennessee. peter.chin@vanderbilt.edu
  • (Accepted for publication April 20, 2016.)
    (Accepted for publication April 20, 2016.)×
Article Information
Correspondence
Correspondence   |   August 2016
Is It Time to Ask Different Questions about Aspiration?
Anesthesiology 8 2016, Vol.125, 425. doi:10.1097/ALN.0000000000001171
Anesthesiology 8 2016, Vol.125, 425. doi:10.1097/ALN.0000000000001171
I read with interest the report by Beach et al.1  on the relationship between nil per os (NPO) time and major adverse events, with special attention to pulmonary aspiration. The authors conclude that NPO status is not an independent predictor of major complications.
As reported in other studies,2,3  the incidence of pulmonary aspiration was found to be quite low, with only 10 cases out of over 139,000 pediatric sedations collected between 2007 and 2011. It is noteworthy that NPO definitions within the Pediatric Sedation Research Consortium database (solids, 8 h; nonclear fluids, 6 h; and clears, 2 h) are out of step with the most recent American Society of Anesthesiologists guidelines from 2011,4  which recommend 6 h for formula/milk and “light” solids, 4 h for breast milk, and 2 h for clear liquids. Many Anesthesiology departments, including ours at Vanderbilt University, Nashville, Tennessee, have moved all solids to a fasting time of 6 h. By this measure, all of the 10 cases of aspiration would have been NPO appropriate with no episodes in those not NPO.
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