If someone goes in for emergency surgery requiring general anesthesia, how do you prevent aspiration assuming they ate beforehand since it was unplanned?
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Not a medical professional, but my understanding is essentially that aspiration is not guaranteed with anesthesia after eating, it’s just a risk that can be minimized. So if there is a surgical procedure being planned, tell the patient not to eat beforehand.
If, however, there’s an emergency and someone will/could die without surgery, then do the surgery, and hope they don’t aspirate (or hopefully, be aware of that risk and do whatever you can to prevent or account for it).
You don’t. Aspiration is a risk, not a guarantee. And if you are having emergency surgery then it’s a risk worth taking. If it happens, they’ll deal with it and whatever the repercussions are.
The anesthesiologist have to pay a lot more attention to the patient to notice when they are about to vomit and then help them out and clear the vomit so the airways stay clear. You may even need to intubate a patient in order to keep the airways clear during surgery. So it is possible to do surgery on patients that have eaten beforehand but it does add more work on the anesthesiologists and adds complications. This all reduces the chance of a successful surgery, adds time to the recovery period and may cause long term damage to the airways and lungs.
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You don’t. It’s emergency surgery, which means it’s:
1. urgently necessary
2. the risk of aspiration is worth taking in the face of alternate outcomes, like death.
They tell you not to eat before surgery to minimize risk. In emergency circumstances that risk is just one you have to take and deal with to try to save a person’s life.
If they’re going to die imminently without immediate surgery, nobody is worried about aspiration.
With planned surgery you just take all of the precautions you can to minimize risk because you can when you’re planning on surgery.
As my anesthetist once explained to me (we were waiting for the OR because the surgery before mine had gone longer than planned), aspiration is a risk, but it’s a fairly small one. They’d rather not take that risk, so if they can avoid it by moving surgery to another day, they will. In emergencies, though, they’ll take the risk because the alternative is that the patient dies. Also, the risk is a bit lower than it used to be, because of advances in the drugs they use for anesthesia.
I’m an anesthesiologist. There are a couple of things we do differently to *reduce the risk* of aspiration. Aspiration is always a risk, even if you haven’t eaten in a day. The risk is just significantly higher if you have a full stomach.
We can do something called a rapid sequence induction, where we put you to sleep and paralyze you as fast as possible to minimize the time between starting anesthesia and securing the airway. We avoid mask ventilation because that can push air into the stomach and increase the risk of vomiting. We can apply pressure to the throat while you’re going to sleep to pinch off the esophagus (though the data for this is minimal and I don’t think it does anything). We can also possibly place a tube through your nose or mouth into your stomach while you’re awake to suction out whatever is inside.
All of these things are unnecessary and create a little more risk in someone who is appropriately NPO, but since they decrease the risk of aspiration they lower the overall risk for someone who is *not* NPO.
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