Most AAOMS Members Have Not Adopted the ASA Recommended NPO Guidelines

The purpose of this study was to determine if AAOMS (American Association of Oral and Maxillofacial Surgeons) members have integrated the current American Society of Anesthesiologists' (ASA) NPO Guidelines into their preoperative instructions.

The investigators designed and implemented a cross-sectional study and enrolled a random sample of US private practice AAOMS members. The predictor variables were year graduated from residency; dual-degree (MD and DDS/DMD) or single; and region. The primary outcome variable was adoption of ASA NPO Guidelines, defined as recommending fasting times of 2 hours for clear liquids and 6 hours for solid foods. To collect data, a systematic online search was implemented. Appropriate uni- and bivariate statistics were computed and the level of significance set at 0.05; 95% confidence intervals were also calculated.

The study sample was composed of 431 (47.9%) clinicians. Almost all (99.1%) of the study sample did not adopt the ASA Guidelines. The fasting recommendations were different than 2 hours for clear liquids and 6 hours for solid foods. However, recommendations of 2 hours or greater for clear liquids were made by 99.8% and recommendations of 6 hours or greater for solid foods were made by 99.3% of OMS. Only 4.4% of OMS had different recommendations for clear liquids and solid foods. No significant association was found between whether OMS adopted the most current ASA Guidelines and year graduated from residency or dual-degree.

OMS in private practice are overwhelmingly recommending longer fasting times for clear liquids and solid foods on their websites when compared to the current ASA Guidelines prior to ambulatory anesthesia. The ASA Guidelines are based on meta-analysis and therefore deviations in practice, while not incorrect, are significant for discussion.

References:

1. 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. Anesthesiology 3:114, 2011

2. Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery (AAOMS ParCare 2012). Journal of Oral and Maxillofacial Surgery 11:70, 2012