Thursday, August 27, 2009

I hate NPO!

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Hydration gone wrong!

I hate NPO! (No food or liquids by mouth for 8 hours or so, prior to having a procedure or surgery)

It's not the food... not at all. I routinely skip breakfast and lunch.. just because I never want to eat early anyway. I know that is a bad habit.. but so hard to break. (And then once I eat..I eat all night) I have been that way since high school.

Oh... and by the time the NPO is lifted.. I am hungry and appreciate the food... but oh my gosh... given a choice of only one of those... I'd choose water every time.

I can not stand to go without water!

And...the thought of it makes me feel a little panicky.

I cannot stand to be thirsty and the only thing that quenches my thirst is water.

I think I get thirstier just because I know I can't have it.

So... I have been drinking all day. Plus it's humid and I was concerned that sweating would cause me to dehydrate more and then I'd be miserable in the morning. And also the IV can be more difficult if the patient is dehydrated.

So I planned to have 32 oz more between 11 and 12 tonight... but a friend called. So I got off track with my drinking. So..I only drank a little of the 1st 160z.

We hung up from our call at 11:45pm and so I practically chug-a-lugged the rest of the water and maybe drank another 8 oz on top of those. I drank all that water in 15 minutes! I didn't feel so good during the last glass. Downright nauseated and had to lie down. I thought I'd be ill but the feeling passed after about 10 or 15 minutes and so here I am..blogging... because now I am going to be whizzie winkling all night!

But I won't be thirsty. Oh heck! Who am I kidding? I'm thirsty even now..but I know it's psychological.

At least with this kind of procedure... I won't have the profound thirst as when in post-op after anesthesia in the OR. That is awful! I feel like my throat is sticking together

I am a bit confused about the NPO rules though.'s always..absolutely nothing allowed in your mouth once you are NPO. But I asked an anesthesiologist if I could chew gum and he..the anesthesiologist himself said I could. Well that was great! That kept my mouth moist. but since then.. the nurses have been adamant that you can't have anything that gets the saliva going, etc... which does make sense. so... did the anesthesiologist and I have a miscommunication? I don't know.

Then last summer..when I met the anesthesiologist in the OR.. I told him I was so dry that my throat felt like it was sticking together and like I couldn't swallow. He said I could've had a little something.

Later I told a nurse about that.. and she said "THEY tell us what to do." and something about mixed messages.

And..when I was in labor with first son..we were told we could suck on lemon lollipops because lemon will activate the saliva (it did) and keep you from drying out.

So..I am curious to know...what exactly are the NPO protocols? Are there minor exceptions depending upon the situation?

And another thing and I have spoken up about this and the anesthesiologist agreed with me. You are told not to eat or drink past midnight. That's all very well and good if you are a morning surgery... but some aren't scheduled until the afternoon and they still tell give you the midnight deadline. I guess surgeries could cancel and so you could go in earlier... but I think the NPO time should be moved forward accordingly ... within a safe margin for cancellations and still getting the 8hrs NPO in. I'm just sayin...

I have to try to sleep now. My bladder doesn't get to sleep tonight. She's been and will continue to be very busy tonight. A foley bag would come in handy right now. :)

Well... assuming I will fall soundly asleep in the next 4 minutes and assuming I won't really wake up when I get up for the whizzie winkle alarm... if I am lucky..I will get 4 1/2 hrs sleep tonight.

I think I may look like who did it and ran tomorrow!

Eh... the girls (my friends ;) and I are going out to lunch afterward. I'll just sleep real well tomorrow night. :)


QuietusLeo said...

The NPO protocols vary from institution to institution and age of the patient (they are a bit more leniant for babies).
But in general before any procedure requiring anesthesia, the patient should be NPO from solid food for 8 hours and from clear liquids (excluding acidic juices like orange juice or lemonade) for 2 hours.
Therefore I usually allow my patients a glass of water 2 hours before the planned anesthetic
(especially if they need to take their morning meds).

SeaSpray said...

Oh Quietus! I want YOU in the OR when I go in! :) I wonder why such a difference in protocol?

Because of a delay, I had one day where I was NPO 14 hours before going into the OR and then of course you have to get through post-op on the other side. Someone said anesthesiologists also give you atropine which also dries you up. Like I said..I have had times where I was so dry that my throat was sticking and I felt like I couldn't swallow and that is a scary feeling. It is worse then the actual thirst.

So you are saying adult patients can drink a *glass* of water 2 hours before surgery. I am conditioned to think even a *sip* for meds is not great.

but are you also saying if it were an acidic juice..they could keep drinking?

certainly..if I had a lemon lollipop.. it would've helped me. all liquids leave the stomach in two hours? ha! The way my bladder works..I think liquids leave in two minutes! ;)

It sounds like you are more advanced in this area over there.

Thank you for your comment. I will ask about this in the fall when I go back in.

LOL! I'd think I had died and gone to heaven if I was allowed a drink. they don't even want to give ice chips. Finally one day.. post-op they let me swab my lips.

Of course I'd rather come out of surgery healthy and not take chances... but darn.. if this is possible then anesthesiologists need to update their protocols both docs and nursing need to get on the same page.

SeaSpray said...

Quietus..just one more thing..or two.

As I said..a couple of years ago one anesthesia doc said I could chew gum and that was great. I was fine in OR. matter of fact that day was the best OR experience I ever had... because of how he did the anesthesia. I woke up *in the OR* so alert and left SDS earlier than they wanted me to and never got sick.

The nurse that heard I was chewing gum got concerned because chewing gum was causing more saliva to go in my stomach.

The same with lemon candy.

What is your take on chewing gum... or sucking on a lemon candy before going into OR?

Chrysalis Angel said...

Years ago when I was scheduled for surgery, I was going crazy with the waiting (I couldn't concentrate at all on what I brought to read). The surgery ended up being pushed back, due to another case, and the waiting area... was a water fountain. I just walked right up to it, and put my mouth to the water instinctively, then wham...remembered I shouldn't drink this, especially at this stage of the game. It was a very close call. All the waiting would have been right down the drain along with the water.

They shouldn't have water fountains where the surgical patients wait. I turned around from the fountain to see Fireguy's mouth wide open - just watching me. I said, "Why didn't you say something to stop me?" He just said he couldn't believe I was doing it, and froze there just watching it play out. Geesh.

QuietusLeo said...

I'll rephrase: clear liquids may be ingested up to 2 hours prior to surgery. Acidic fluids should not be ingested at all.
The reason we are so stringent about the fast is that residual stomach contents are sometimes regurgitated and if inspired will cause aspiration pneumonia (a serious complication). Most research shows that the higher volume rather than acidity is more consistently correlated with this complication, however conventional wisdom still precludes acidic juices.
The chewing gum issue is one that has never come up in my practice. However it makes sense that it causes increased salivation which is ingested thus increasing stomach contents.
Atropine is administered along with the drug neostigmine (which is itself administered as the antidote for muscle relaxants used in some surgical procedures). Atropine counteracts the side effects of neostigmine. Especially important are increased secretions and bradycardia (slow heart rate even down to zero!). Atropine itself has side effects including dry mouth. If I have to choose between dry mouth and no pulse, dry mouth wins every time. Therefore, atropine should always be administered when neostigmine is used.

SeaSpray said...

Awww Angel! Fortunately for me..I have been back in SDS and no where near a visible water fountain that I've ever noticed! That would be torture beyond measure. must have felt awful to have just gone over to do that. And can you imagine if you had to tell staff you caved and drank the water?

LOL! Funny husband reaction. I'm like that. sometimes I can't believe something is happening and I process to see if it is REALLY happening.

SeaSpray said...

Quietus, I can understand the fast but not the fluids. I am sure they drain out faster than 8 hours and think 2 hours would be all that was needed...certainly by 4 hours!

I wonder why why seem to be behind in this?

I realize that it is always better to err on the side of caution... but I am absolutely bringing this up with anesthesia when I go back.

I know I wine about the fluids... but I'm 100% with you on the atropine.

It must be so tricky to manage the various drugs given that there are so many variables with different patients or even with one patient.

QuietusLeo said...

Water in a healthy person is usually out of the stomach by 5 minutes. However there are conditions, diseases and situations when gastric emptying is delayed. Even though 2 hours NPO seems like overkill it really isn't. Aspiration pneumonia is such a serious complication that no self-respecting anesthesiologist will forgo at least 2 hours NPO even for water unless delaying surgery endangers the patient.

SeaSpray said...

Oh Quietus..I don't think 2 hours without water is overkill. I think that would be miraculous! I'd think I died and went to heaven. ;)

What do you think of keeping a patient NPO (no fluids)for 8 hours minimum like they do here? Then if surgery delayed... it can go 10-12 hours and I have gone longer.

2 years ago.. I ended up in the ED around 5ish. I think it was by 7 that I actually got inside. I was immediately put on NPO because doc wasn't sure and then thought I had pancreatitis, *possibl* small gallstones..might need and ERCP, etc. I didn't get up to my room until approximately 5am. I was then still being kept npo and would have until a specialist came in to see me because they didn't know if I'd need surgery. (I was MISERABLE!) Fortunately... my private doc came in later that morning and said I didn't need to stay and I didn't need an ERCP, etc because he felt that I had reacted to an office uro procedure because of having percocet on an empty stomach. He was right and I was fine.. thank God. I don't know why the ED doc was so wrong. My regular PCP has since told me that people can have complications from ERCPs and agreed I wouldn't have needed that based on what I told him.

All that..and the point I am really trying to make is that the nurses didn't seem concerned that I hadn't had anything to drink in so long.. they all parroted the npo order.

I don't think any medical people actually stop to think unless pushed.. that a patient is really suffering when npo for extended periods and I mean 12 hours and up especially. I have only gotten ice chips or swabs if really stressing my throat is sticking together and believe me..that is a frightening feeling when you think you may not be able to swallow because you don't have any saliva. I'd say that is dehydrated. And that wasn't because in post-op because of atropine.. that was before going into the OR. Well the day I got swabs was post -op but doc didn't know if I was going back in. Now.. I can understand that because I could've ended up going right back in.. but luckily I didn't.

You do it better in Israel! :) And I really wonder why they seem so behind with this?

le0pard13 said...

This is wonderful post and blog. I glad I found it as I was doing a quick reference for my own recollection re: this acronym. I plan on following your pieces. Thank you.

SeaSpray said...

Thank you for your kind words leopard13 and thanks for stopping by... and the link. :)

Julie Hughes said...

NPO is hell on earth for me! I've had gastric bypass surgery, and an unusual procedure, so my anatomy is COMPLETELY different...the only part of my stomach left is the gastric cardia, my stomach acid is below the roux-en-y branch, meaning it would have to travel the length of my entire intestinal tract to aspirate...meaning it can' "stomach" empties immediately because it CAN'T hold anything, so I dehydrate immediately if I don't drink nearly constantly, AND the half dozen meds I'm on ALL cause dry mouth...
For a couple of years I followed their directions, and it would take 3 hours to find a vein, I suffered complications during surgeries, would have massive migraines for 3 days due to dehydration...
Then I gave up and stopped arguing against rules based on false assumptions...I talked to my surgeon and he told me what was appropriate for my anatomy...
I tried explaining it to a the first few anesthesiologists I had afterward...they went along, but still threatened to cancel procedures in the future...
Now I just lie. Yep. NPO 6 hours. Right. Sure. Whatever makes you feel better.
What I would like to know is how to deal with the dry mouth after I DO stop drinking. I am known to gargle...I'd love to find a mouth mister or something...Is it okay to wet your mouth as long as there is no swallowing involved?

SeaSpray said...

High Julie.

Thank you for your comment.

I'm not a medical worker and so I can't advise.

But ..I would say no.

I drink a LOT of water all day before and maybe 320z between 11 and midnight. :)

A few times when I was a frequent flier to OR ...I did get some differing advice.

One anesthesiologist said gum was okay. All other anesthesiologists said no gum because it increases saliva production. Same with no hard candy either. In Israel (see comment at top ..they go a shorter duration, but I would ALWAYS follow the advice of the doctors and staff.

The only thing if you know you are scheduled late in the day ..ask if you can begin NPO later than midnight. Of course if you get bumped up to earlier time then that is a problem. The thing is you know your body and so ask questions if it isn't working for you.

I would be concerned about misting or gargling because I would be afraid some fluid could slide down throat. I even brush teeth totally facing down at sink because I am afraid to let anything slide down my throat.

God forbid aspirating anything into lungs because stomach wasn't empty!

However urologist let me use mouth swabs when in the hospital. I was so dry post-op my throat was beginning to stick together, which was exacerbated by the Atropine they gave in the OR. But there was a chance I might go back in. Thankfully I didn't have to.

The mouth swabs are little sponges on a stick. I think they are pre-moistened. Don't recall now.

I wish I could be more helpful - but always do what your physician tells you to do.

Sometimes the nurses will just state the NPO orders without looking at your personal situation and so you need to be your own advocate and speak up if a problem. It sounds as though you already do.

I once had a doctor tell me to do NPO at midnight when I wasn't gonna go in OR until end of day, meaning it would've been 17 hours. I expressed concern and it was revised.

It sounds as though you have been through so much with that surgery. I hope it worked out for you. :)