NPO guidelines and liquids. Which ones are considered clear?

[propadope]

I realize that NPO guidelines are not necessarily based on scientific evidence but how would you treat liquids like orange juice without pulp? Is that considered ‘clear’? The ASA states that fruit juices without pulp are considered ‘clear’ but I have always thought that to include stuff like apple juice.

What if its orange juice WITH pulp? Obviously not considered clear but how long would you wait? 4hours? 6 hours?

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[jwk]

Orange juice always has particulate matter in it, even if there's no pulp. Apple juice is clear.

If it's not "clear fluids", it's 6 hours in our shop.

 

[deleted171991]

I realize that NPO guidelines are not necessarily based on scientific evidence but how would you treat liquids like orange juice without pulp? Is that considered ‘clear’? The ASA states that fruit juices without pulp are considered ‘clear’ but I have always thought that to include stuff like apple juice.

What if its orange juice WITH pulp? Obviously not considered clear but how long would you wait? 4hours? 6 hours?

If there is no pulp (or any additive that's either particulate or would delay stomach emptying), why wouldn't it be clear? Just because it's not see-through? Neither is coffee, still most of us allow it.

Playing the devil's advocate here.

 

[deleted171991]

Orange juice always has particulate matter in it, even if there's no pulp. Apple juice is clear.

If it's not "clear fluids", it's 6 hours in our shop.

Have you tried to strain it? 😉

 

[deleted171991]

So, orange juice is NOT mentioned in https://www.asahq.org/~/media/sites...ctice-guidelines-for-preoperative-fasting.pdf, except as a reference article.

I read the reference and it says:

Abstract

In order to assess the effect of preoperative oral fluids, with and without ranitidine, on gastric fluid volume and pH, 300 elective surgical inpatients, ASA physical status I or II, were randomly assigned to one of six groups. The three groups that received placebo are discussed in this paper, Part I, and the three that received ranitidine in Part II. Between two and three hours before the scheduled time of surgery patients received either 150 ml coffee (Group 1), or 150 ml orange juice (Group 2), while the control group continued their overnight fast (Group 3). No opiate or belladonna premedication was given. Immediately following induction of anaesthesia the residual gastric fluid was obtained by suction on a nasogastric tube and its volume and pH measured. Residual gastric fluid volumes showed no statistically significant differences among the groups (Group 1: 24.5 +/- 21.6 ml; Group 2: 23.7 +/- 18.4 ml; Group 3: 23.2 +/- 17.3 ml; p greater than 0.1). Values for pH among the groups were also similar (Group 1: 2.18 +/- 1.58; Group 2: 1.95 +/- 1.24; Group 3: 1.95 +/- 1.62; p greater than 0.1).

Gastric fluid volume and pH in elective inpatients. Part I: coffee or orange juice versus overnight fast - Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Afin ďévaluer ľeffetde ľingestion de liquide par voie orale en période préopératoire avec ou sans ranitidine sur te volu

link.springer.com

Hence, the 😈 is right. A small cup of orange juice seem to be like coffee or fasting, for NPO purposes.

 

[Iso4ane]

I think the more interesting question are things like jello and in particular thickened liquids (like nectar or honey thick water.)

 

[propadope]

If there is no pulp (or any additive that's either particulate or would delay stomach emptying), why wouldn't it be clear? Just because it's not see-through? Neither is coffee, still most of us allow it.

Playing the devil's advocate here.

I don’t disagree with you. I just thought ‘fruit juice without pulp’ could potentially be misinterpreted. The reason I asked is because I had a kid that had orange juice without pulp today. I had seen the study that looked at coffee and orange juice and I ended up seeing the kid based on that. Just wasn’t sure if it was consistent with the ASA guidelines.

 

[commenteitor]

How about vodka?

 

[jwk]

How about vodka?

Clearly OK 🙂

 

[jwk]

Have you tried to strain it? 😉

I figure if it settles out in my refrigerator overnight and I have to shake it up before pouring, it's got particulate. But I defer to your study 🙂

 

[propadope]

Clearly OK 🙂

Its clear innit?

 

[IMGASMD]

Its clear innit?

Is that where Everclear get its name from?

 

[nimbus]

Then how about a screwdriver?

Vodka cranberry is obviously 2hrs.

 

[dabears505]

The benefit of the vodka is decreased anesthetic requirements. With all this talk of multimodals, I'm not sure how a shot 2 hours prior to arrival is not in the patients pre op instructuons

 

[deleted697535]

gastric ultrasound? if empty, rsi with sux. if full - delay

 

[deleted171991]

I don’t disagree with you. I just thought ‘fruit juice without pulp’ could potentially be misinterpreted. The reason I asked is because I had a kid that had orange juice without pulp today. I had seen the study that looked at coffee and orange juice and I ended up seeing the kid based on that. Just wasn’t sure if it was consistent with the ASA guidelines.

I wasn't sure either (we do advise "clear apple juice" on our preop forms). Until I looked it up. Thank you for the interesting question.

 

[deleted171991]

gastric ultrasound? if empty, rsi with sux. if full - delay

I like the idea, just not for orange juice. See above why.

 

[deleted171991]

The benefit of the vodka is decreased anesthetic requirements. With all this talk of multimodals, I'm not sure how a shot 2 hours prior to arrival is not in the patients pre op instructuons

Makes the patient unconsentable.

 

[Iso4ane]

I figure if it settles out in my refrigerator overnight and I have to shake it up before pouring, it's got particulate. But I defer to your study 🙂

But, milk....