Developing Comprehensive Nil Per Os Guidelines for the Pediatric Anesthesiologist in 2025

The American Society of Anesthesiologists (ASA) most recently released guidelines for preoperative fasting in 2023, which aim to minimize the risk of aspiration in healthy patients undergoing elective procedures. Although these nil per os (NPO) guidelines are intended to be comprehensive for this patient population, they leave significant room for interpretation. To address this, we created modified pediatric anesthesia NPO guidelines within our institution based on existing published evidence and anesthesiology faculty consensus. Implementing these guidelines has provided a more consistent approach to preoperative care for patients, families, and providers.