Anesthesia practice guidelines are out of control, too many to adopt, too anecdotal to accept and too political to take seriously! Clinicians are already ignoring and pushing back on guidelines. A study presented at the recent ASA annual meeting examined whether hospitals in Michigan adhere to ASA NPO (nothing by mouth) guidelines, and found the majority do not. We should stop pretending all guidelines are sacrosanct, even those of the ASA, and winnow them to the few that are. Cutting the bad ones will elevate the good ones. Societies that continue to spew weak and conflicted guidelines should be called out, even mocked.

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