Do I need to be Nil Per Os (NPO) before cataract surgery?

NPO Guidelines for Cataract Surgery

Preoperative fasting from midnight is unnecessary for cataract surgery patients. You should follow modern guidelines allowing clear fluids until 2 hours before anesthesia and solids until 6 hours before the procedure. 1, 2

Evidence-Based NPO Recommendations

General NPO Guidelines

• Clear liquids: Allowed up to 2 hours before anesthesia
• Light meals/solids: Discontinue at least 6 hours before anesthesia
• Essential medications: Take with small sips of water on the morning of the procedure

Rationale for Updated Guidelines

Modern evidence shows that prolonged fasting:

• Does not reduce aspiration risk 3
• Can lead to patient discomfort and dehydration 2
• May negatively impact patient experience and recovery

Special Considerations for Cataract Surgery

Cataract surgery is considered a low-risk procedure that typically:

• Is performed under topical or regional anesthesia 4
• Has minimal risk of adverse outcomes
• Can often be completed with minimal sedation

Risk Stratification

For standard cataract surgery patients (low aspiration risk):

• Follow the 2-hour clear liquid/6-hour solid food guidelines
• Encourage hydration with clear fluids up to 2 hours before surgery

For high-risk patients (those with severe heart failure, severe pulmonary hypertension, or hemodynamic instability):

• More conservative NPO guidelines may be appropriate 2
• Consult with anesthesiology for individualized recommendations

Preoperative Management for Cataract Surgery

The ophthalmologist performing cataract surgery should:

1. Ensure appropriate preoperative fasting instructions are provided
2. Consider ocular comorbidities that may affect the surgical approach 1
3. Formulate a comprehensive plan including anesthesia selection 1

Common Pitfalls to Avoid

1. Outdated "NPO after midnight" practices - This traditional approach has been shown to be unnecessary and potentially harmful 3
2. Excessive fasting - Can lead to dehydration, patient discomfort, and hypoglycemia 2
3. Inconsistent instructions - Clear communication about which medications to take or hold is essential 2

Conclusion

The evidence strongly supports allowing clear fluids until 2 hours before cataract surgery and solids until 6 hours before. This approach balances safety concerns with patient comfort and physiological needs. Liberalizing preoperative fasting policies has not been shown to increase cancellations, delays, or aspiration events 5.