Sips of Water with Medications Before Surgery
Patients can safely have sips of water with medications up to 2 hours before surgery, as this does not increase aspiration risk compared to traditional fasting from midnight. 1, 2
Guidelines on Preoperative Fluid Intake
Clear Fluids
- Current evidence-based guidelines strongly recommend allowing clear fluids (including water) up to 2 hours before anesthesia 1
- Traditional "NPO after midnight" practices are unnecessary and outdated for most patients 1, 2
- The 2021 ESPEN guidelines provide a Grade A recommendation (97% agreement) that patients without specific aspiration risk can safely drink clear fluids until 2 hours before anesthesia 1
Medications with Water
- Taking medications with small sips of water is considered safe within the 2-hour preoperative window 2
- The volume of liquid is less important than the absence of particulate matter 1
- Generally, up to 400ml of clear fluid is considered safe within the 2-hour window before surgery 2
Benefits of Allowing Sips of Water with Medications
- Reduces patient discomfort including thirst and headaches 1
- Prevents withdrawal symptoms from medications 1
- Maintains proper hydration status 2
- May contribute to better postoperative outcomes 2, 3
- Does not increase risk of aspiration or regurgitation compared to traditional longer fasting 1, 4
Special Considerations
Patients at Higher Risk
- Additional restrictions may be appropriate for patients with:
- Morbid obesity
- Diabetes mellitus
- Difficult airway
- Known delayed gastric emptying
- Gastroesophageal reflux
- Emergency surgery 1
Solid Foods
- Solid foods should still be avoided for 6-8 hours before surgery 1
- The distinction between clear liquids and solid foods is important for patient safety 2
Common Pitfalls to Avoid
- Following outdated "NPO after midnight" instructions regardless of surgery time 2
- Confusing guidelines for solid foods with those for clear liquids 2
- Allowing milk-containing or high-protein beverages, which require longer fasting periods 2
- Becoming unnecessarily dehydrated before surgery 2, 3
Implementation in Practice
Despite strong evidence supporting shorter fasting times for clear liquids, many institutions still follow traditional prolonged fasting practices 5. Studies have found that actual fasting times often far exceed recommendations, with mean fasting times for fluids of 12.5 hours in some studies 5.
The evidence clearly supports that small sips of water with medications up to 2 hours before surgery is safe and beneficial for most patients undergoing elective procedures.