Pre-Operative NPO Recommendations
There are many medications patients should take with a small sip of water when NPO and awaiting surgery. Here are some recommendations from Anesthesia Associates of Boise. Staff should always follow surgeon/proceduralist directions if provided.
- Continue beta blockers and diuretics.
- Hold any ACE medications DAY OF SURGERY unless otherwise directed.
- Hold any ARB medications DAY OF SURGERY unless otherwise directed.
- Hold phentermine for 7 DAYS prior to surgery.
- Continue analgesics. Patients who are opioid tolerant and on chronic narcotics, such as oxycodone or fentanyl patches, should continue their medication. Patients taking gabapentanoids (pregabalin and gabapentin) and acetaminophen should continue taking these medications.
- Continue GI prophylaxis medications, such as H2 blockers and proton pump inhibitors.
- Diabetics: Hold oral hypoglycemics day of surgery. Any diabetic patients taking insulin should follow the instructions of their surgeon, PCP, or the pre-operative hospitalist if consulted for management.
- Continue anti-seizure medication.
- Please use your judgment with other medications or refer to the perioperative medication management document on this website. Most of them are probably not necessary on the day of surgery.
Simplified MINIMUM NPO guidelines: (excluding medications)
- 2 hours for clear liquids (CLEAR juices with no pulp, plain jello, black coffee, CLEAR sodas*)
- 4 hours for breast milk
- 6 hours for infant formula
- 8 hours for non-clear liquids and solids** (includes non-human milk, hard candy and chewing tobacco)
Longer fasting times improve flexibility in moving cases up. When in doubt, follow surgeon instructions.
Anesthesia recommends Ensure Pre-Surgery as the clear carbohydrate drink of choice.
If Ensure Pre-Surgery not available or provided, an alternative 8oz CLEAR carbohydrate drink with NO PROTEIN such as a soda or Gatorade is encouraged no later than 2 hours prior to surgery unless contraindicated by surgeon (diabetic patients excluded).
**Gastric tube feedings are considered solids.