Can a patient be NPO (nothing by mouth) with sips for medications the day before surgery?

Preoperative Fasting Guidelines: NPO with Sips for Medications

Patients can safely take medications with small sips of water (up to 30 mL) on the day of surgery, even when NPO (nothing by mouth) status is required. This practice is supported by current evidence-based guidelines and does not increase aspiration risk 1.

Current Evidence-Based Fasting Guidelines

• Clear fluids: Allowed up to 2 hours before anesthesia induction
• Light meals: Allowed up to 6 hours before anesthesia induction
• Medications: Can be taken with small sips of water (up to 30 mL) even during NPO periods

The traditional "NPO after midnight" approach has been replaced by more nuanced, evidence-based guidelines that improve patient comfort while maintaining safety 1, 2.

Specific Recommendations for Medication Administration

1. Essential medications should be continued on the day of surgery with small sips of water

   • Antihypertensives, cardiac medications, anticonvulsants, and other chronic medications should generally be continued
   • The small amount of water used to swallow pills (≤30 mL) does not increase aspiration risk

2. Medication-specific considerations:

   • Diabetes medications: Hold oral hypoglycemic agents on the morning of surgery; adjust insulin per protocol 1
   • Anticoagulants/antiplatelets: Follow procedure-specific protocols
   • Pain medications: Continue as directed to prevent withdrawal 1

Benefits of Allowing Sips of Water with Medications

• Prevents medication non-compliance (which affects 26-40% of surgical patients) 3
• Reduces risk of adverse events from missed doses of critical medications
• Improves patient comfort by reducing thirst and anxiety 1, 4
• Does not increase aspiration risk compared to traditional longer fasting periods 2

Implementation Tips

• Provide clear written and verbal instructions about which medications to take and which to hold 3
• Specify that medications can be taken with small sips of water (≤30 mL)
• Educate patients on the importance of following medication instructions 5
• Use standardized, simplified instruction sheets that clearly indicate which medications should be taken 3

Common Pitfalls to Avoid

• Unnecessarily withholding critical medications due to misunderstanding of NPO status
• Failing to provide clear instructions about medication administration
• Confusing guidelines for solid foods with those for small sips of water with medications
• Following outdated "NPO after midnight" instructions regardless of surgery time 4, 6

Recent quality improvement initiatives have successfully reduced unnecessary NPO past midnight orders by 50-67% without increasing complications 6, demonstrating that evidence-based approaches to preoperative fasting are both safe and beneficial for patients.