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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Anesthesiology: More than intubating and propofol
By Daniel Orlovich, MD, PharmD

Editor’s Note:  Did you ever wonder what medical students think when they start their first anesthesia rotation?  It must seem overwhelming. Daniel Orlovich, then a fourth-year medical student at the University of California, Irvine, wrote down these observations about his first days on our side of the ether screen. For me, his essay is a great reminder of how remarkable everything looks through fresh eyes, and how every new task may be a learning experience. Dr. Orlovich is now about to begin his anesthesiology residency at Stanford. We hope he will keep us posted on his progress!

“How’s she doing?”

The attending anesthesiologist asked me that question about the intubated and unconscious patient on the operating room table.

“Well…”  I crossed my hands. Up to this point in medical school, every patient or parent I met was able to speak to me. But there was no chance I could ask this patient a question. I couldn’t even start an H & P.

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