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Anesthesia on an Other Than Empty Stomach

Clifford Gevirtz, MD, MPH
JAMA. 1990;264(1):33. doi:10.1001/jama.1990.03450010037013.
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To the Editor.—  Dr Meyer,1 in his response to the question of mandatory "NPO" status for elective ambulatory surgery, expresses a humane and sensitive approach to this vexing problem. However, I was disappointed that he did not address the use of metoclopramide,2(p438) of nonparticulate antacids,2(p435) or of histamine2-receptor antagonists3 in those ambulatory patients who have committed the minor transgression of stimulating gastric secretion by consumption of small amounts of clear liquids or chewing gum and candy.I would add to his suggested strategies that some combination4 of the above agents might lessen the physical risk for these specific patients, as well as the medicolegal risk for the anesthesiologists. I would also caution against taking comfort in documenting the fact that the patient is accepting a slightly increased risk. The legal standard of maintenance of NPO status is firmly entrenched and even the most

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