Reducing the Time Children Must Go without Drinking before Anesthesia for Same-day Surgery

Published on in CHOP News

Safety pin iconPromote Health & Healthy Communities

Why is this important?

We often ask parents not to let their children drink too soon before anesthesia to avoid complications during surgery (vomiting and aspiration). In the past we allowed children undergoing anesthesia at Children’s Hospital of Philadelphia (CHOP) to drink clear beverages like apple juice or water up to two hours prior to hospital arrival.  Since most patients were told to arrive at least one hour prior to their surgery start time, children were “NPO,” a medical term that refers to “nothing by mouth,” for at least three hours. Baseline data showed that the average NPO time was actually closer to eight hours for most children. Based on interactions with parents and caregivers, providers believe this is in part due to families feeling that “longer is better,” when in fact, drinking fluids closer to surgery ensures the child is well-hydrated. These factors all tie in to one of the biggest complaints from families about their perioperative experience — long wait times and long fasting times.

What we did

A multidisciplinary team of anesthesiologists and perioperative clinicians across our preoperative units outlined the factors that contribute to prolonged fasting times. Recent research demonstrates that it is safe for most children to drink up to an hour prior to anesthesia, and some institutions outside the U.S. have liberalized their fasting guidelines accordingly. Our QI team updated our fasting guidelines to be in line with the most current research so that children are now allowed to drink up to 30 minutes before arrival rather than two hours. After implementing this change, we monitored case delays, cancellations, and vomiting events to make sure the new guidelines did not make anything worse. We also assessed patient and family satisfaction.


Since our improvement work started, the percent of patients with NPO time ≤ 4 hours has doubled.


Percent of Main Campus day-surgery patients with a NPO time ≤ 4 hours.

Graph: Percent NPO clears case less than or equal to 4


Percent of Ambulatory Surgical Centers (ASCs) day-surgery patients with a NPO time ≤ 4 hours.

Graph: Percent NPO clears case less than or equal to 4

Updated May, 2020

Next Steps