Preoperative fasting for elective surgery in a regional hospital in Oman

Mohammed Al Maqbali

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


A fasting period before anesthesia is necessary to avoid the aspiration of stomach contents, which can be threatening to the patient's life. Guidelines from professional societies in the USA and UK recommend that healthy patients fast for 6 hours from solid food and 2 hours from liquids. Despite this, many institutions still practice nil-by-mouth after midnight. This can affect the patient's recovery after surgery, and increase the length of stay in hospital. The aim of this study was to assess the duration of fasting before elective surgery on the part of adult patients.

A prospective study was conducted to identify the fasting time and complications among surgical patients undergoing elective surgery over a 4-month period. The patients were asked for preoperative fasting times, and the complication. The demographic data were taken from the patients' files.

A total of 169 patients were included in the study, 88 male and 81 female. The minimum and maximum fasting hours with regard to food were 7 hours and 19 hours, respectively; all the patients fasted from food for longer than the recommended time. The minimum and maximum fasting hours for fluids were 4 hours and 19 hours, respectively; all the patients fasted from fluid for longer than the recommended time.

Most of the patients fasted from food and fluids for more than the time recommended by the American Society of Anaesthesiologists, the Royal College of Nursing, the Association of Anaesthetists of Great Britain and Ireland and the Royal College of Anaesthetists. Excessive fasting could lead to discomfort and possible morbidity in surgical patients. The surgical team needs to collaborate to reduce the fasting time by revising the operative list.

Preoperative fasting is essential for patients undergoing elective procedures. The traditional order for preoperative practice is that patients should be NPO—non per os or nil per os: nil by mouth—after midnight. John Snow was the first clinician, in 1847, to mention the need to be ‘sparing’ in terms of breakfast or lunch before surgery, for a period of 2–4 hours (Eger et al, 2014).

Preoperative fasting is important to prevent vomiting and the aspiration of stomach content into the lung (Frandsen, 2012). During his work in obstetric anaesthesia, Mendelson found a 15% incidence (66 patients) of pulmonary aspiration among 44 016 patients receiving general anaesthesia (Mendelson, 1946). Of the 66 patients, 2 died. Mendelson recommended emptying the stomach before general anaesthesia. As a result, strict NPO after midnight continued for decades.

In 1999, the American Society of Anaesthesiologists (ASA) published guidelines for preoperative fasting (ASA, 1999), updated in 2011 (ASA, 2011). ASA recommended minimising the preoperative duration of fasting time for healthy patients undergoing elective surgery. The fasting guidelines were for a cessation of clear liquids for 2 hours, as well as solid foods for 6 hours before anaesthesia. The Royal College of Nursing (RCN) developed guidelines for nurses regarding the fasting protocol (RCN, 2005). These guidelines advise that water or clear fluid can be given 2 hours before the induction for adults and children, which contributes to patients' wellbeing. In addition, other healthcare organisations—such as the Association of Anaesthetists of Great Britain and Ireland (AAGBI) (2015) and the Royal College of Anaesthetists (RCoA) (2012)—also supported the ASA guidelines by recommending the same period of fasting. Table 1 summarises the fasting guidelines in terms of the minimum fasting period.

Original languageEnglish
Pages (from-to)798-802
JournalBritish Journal of Nursing
Issue number14
Early online date28 Jul 2016
Publication statusPublished online - 28 Jul 2016


  • anaesthesia
  • surgery
  • fasting
  • nutrition
  • improving practice


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