Effect of NPO status on aspiration risk in pediatric patients undergoing procedural sedation

Objective:To conduct a review of literature to determine if no solid food or liquids by mouth for more than or less than six hours impacts the incidence of pulmonary aspiration during procedural sedation in pediatric patients. Methods: A PubMed search was conducted utilizing the following terms: “sedation, fasting, and aspiration” and “NPO, pediatrics, and pre-procedural.” Filters included: “within five years,” “review articles,” and “English.” Articles were then screened and assessed for eligibility based on pediatric population, NPO status, procedural sedation, and risk of pulmonary aspiration. Results: Two prospective observational studies and one retrospective review were selected. Beach et al.8 and Clark et al.10 found no statistically significant difference between NPO status and the incidence of pulmonary aspiration. Andersson et al11 found that allowing clear liquids up until called to the operating room does not increase the risk of pulmonary aspiration when compared to patients who fasted more than two hours. Conclusion: Overall, these studies found that NPO status does not independently increase the risk of aspiration. Future studies need larger sample sizes in order to properly assess the risk of pulmonary aspiration in pediatric patients undergoing procedural sedation