Before a surgical procedure, patients receive specific instructions about what they can and cannot consume. These guidelines often include seemingly minor items like mints. Adhering to these instructions is a fundamental aspect of preoperative care, designed to safeguard a patient’s well-being during and after surgery.
The Fasting Rule Before Surgery
A standard instruction before surgery is “Nil per os” (NPO), a Latin phrase meaning “nothing by mouth.” This directive is a medical principle that requires patients to abstain from food and drink for a specified period prior to anesthesia. The primary purpose of NPO is to ensure the stomach is empty, which significantly reduces the risk of pulmonary aspiration during anesthesia.
Pulmonary aspiration occurs when stomach contents enter the lungs. Anesthesia medications relax the body’s protective reflexes, including the ability to cough or gag, which normally prevent foreign material from entering the airway. If stomach contents are regurgitated while these reflexes are suppressed, they can be inhaled into the respiratory tract, leading to serious complications.
Why Mints are Specifically Excluded
Mints are specifically excluded from pre-surgical fasting for several reasons. Mints can stimulate the production of gastric acid and increase the volume of stomach contents. This occurs because the act of tasting and dissolving the mint signals the digestive system to become active, anticipating food intake. The presence of gastric acid and increased liquid in the stomach poses a significant risk if aspirated.
Aspirating acidic stomach fluid can cause severe lung damage, leading to a serious condition known as aspiration pneumonia. This chemical pneumonitis can result in inflammation, infection, and even acute respiratory distress syndrome (ARDS), which can be life-threatening. The goal of preoperative fasting is to achieve a truly empty and inactive stomach, and mints interfere with this by prompting digestive activity. Any oral intake, including saliva stimulated by a mint, can become a risk once protective airway reflexes are diminished by anesthesia.
What Happens if the Rule is Broken
If a patient consumes anything, including a mint, against the NPO instructions, the surgical team must be informed immediately. The most common consequence is the postponement or cancellation of the surgery to ensure patient safety. Should aspiration occur, potential complications include aspiration pneumonia, which may necessitate an extended hospital stay, intensive care, or even prove fatal. Anesthesiologists are strict about NPO guidelines because patient safety is paramount, and non-adherence introduces preventable risks.