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).
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