NPO After Midnight


Feb 06, 2012
3296-1's picture

The phrase “NPO After Midnight” is one of the most common in medicine. It is present not only in physician’s pre-operative orders, but repeated by nurses, ward secretaries and dietary workers. Indeed NPO, nil per os in latin, maybe one of the oldest phrases in the western medical lexicon. Where did the midnight part come from and does it still serve us and our patients? I believe it does not, and should be replaced by more meaningful, understandable and evidence-based instructions.

In the olden days, patients having almost every kind of elective surgery requiring general or regional anesthesia, even the most minor, were admitted to the hospital (the only kind of institution where surgery was performed) the night before the scheduled procedure. The nursing staff prepared them that evening in appropriate ways, for the morning procedure and understood that the goal of “NPO after midnight” was to ensure an empty stomach. Patients were taken to the OR in the morning directly from their ward rooms.

Nowadays, patients sleep at home or in a hotel the night before surgery, get up in the morning at an hour that only farmers and fisherman would find reasonable, and arrive at the hospital or surgery center several hours before their scheduled procedure. Many of these patients...

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