I know that with elective surgeries, patients have to fast the night before to prevent vomiting when they go under anesthetic, but I was wondering how this concern is navigated in trauma or emergency surgeries in which patients definitely didn’t fast the night before? Do they just try to deal with the vomit or is there a special procedure to prevent vomiting from occurring?
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This is more related to anesthesia than surgery
Anyway, there is a method called rapid sequence intubation where anesthesiologists will give fast acting medication to put the patient under and put the breathing tube in. Usually~~ you give patients oxygen before attempting to put in the breathing tube, but here they forgo that since it adds more time they could potentially vomit.~~ They also position the patient with the head higher up to avoid effects of gravity or their belly on their stomach. Once the tube is in the trachea, there is an inflatable cuff around it that seals the wind pipe so if the patient did vomit it wont go into the lungs.
Its still a risky procedure, so typically only done during life or death cases.
There are some of the anesthesia drugs, like propofol, that have antiemetic effect but really trauma surgery is all about risk/benefit. If immediate surgery is required to save life or limb, then the risk of aspiration is worth taking. Also many emergency procedures now, like say appendectomy, can be done using a spinal and so the risk of aspiration goes way down without intubation. Also, in general, the science has changed on preoperative fasting, and unless you are having major bowel surgery, you can down have clear fluids up to a few hours before a lot of procedures. It has been recognized that the negative impacts of fasting on blood sugar (especially for diabetics), body temp regulation, and post op recovery is often greater than the risk of aspiration. Source – am RN.
It’s an emergency, so you do your best under the circumstances and deal with complications as they come.
In the case of anesthesia, they’re worried about the possibility of the drug making the patient vomit, or worse, vomit just a bit and then inhale it back into the lungs. If you plan the surgery, you can plan on the person having an empty stomach, but in the emergency room you assume it’s full, hope for the best, and be prepared for the worst.
One thing they can do is run a tube down the airway to keep it open and free from contents from the stomach. There’s an entire procedure for doing this quickly before the surgical procedure begins.
But it’s still emergency medicine: hope for the best, prepare for the worst, prioritize in order of criticality.
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I had an emergency appendectomy and while I hadn’t eaten anything for the previous day due to severe pain, They ended up needing to do a CT to diagnose because I wasn’t presenting the textbook case for appendicitis. Ct scan I had to drink a giant tub of contrast agent, and when I came out of anesthesia I managed to throw it all up and inhale it into my lungs. Since it was general I only have vague memories of this but there was a lot of being encouraged to cough and the next day.everyone on the surgical team came to look at my mouth which I believe was scraped up from them vacuuming contrast agent out of my lungs. So that’s exactly why they asked that your stomach be empty. I don’t have any medical background but doctor internet says that I probably had a one in five chance of dying from aspiration of my stomach contents.
Trauma anesthesiologist here. When we induce anesthesia for your surgery you lose your airway reflexes. When this happens due to the drugs we have given you, you also lose smooth muscle tone. If you have food or fluid in your stomach, this can reflux into your trachea and into your lungs causing you to aspirate. We take this risk of intubating you with a full stomach (putting a breathing tube into your lungs that can also keep gastric contents out of your lungs) because the alternative is loss of life or limb. This can be due to you having suffered a gunshot wound to your stomach damaging major organs and causing you to bleed to death, or major trauma from a car accident leading to organ injury. This is typically done with a rapid sequence induction which is where someone holds pressure on your trachea in an attempt to compress your esophagus while we intubate in order to decrease the risk of aspirating gastric contents.
Risk management. If you have an elective surgery, there’s time to go for maximum risk reduction e.g. two showers with chlorhexidine before the surgical site is sanitized multiple times anyway. Aspirating *could* be a problem that *might* be a complication, so avoid anything that *might* cause it.
But if the patient is at .12 blood alcohol after clubbing all night and needs trauma surgery from a car wreck and can’t tell you *what* they’ve eaten and / or used besides booze, well, this is the hospital.
The reason they ask you to fast is because a lot of anesthetics make you puke. If you puke while unconscious, you can aspirate the vomit, and then you need medical attention and it’s just one more thing for them to deal with while you’re on the table.
So, they ask you to fast because it’s safer and easier for you and them. But it’s by no means a requirement.
The problem is that we’re talking trauma surgery. It’s all risk vs. benifit.
If they gotta do something, they gotta do it; there’s no avoiding it. If a problem occurs, they can deal with it when they get there, if they get there.
That said, the main problem with eating before surgery is just that when they tube you, it can kinda cause you to throw up, and they don’t want you to blow chunks up their pipe.
Anesthesia can help with it, but ultimately, see paragraphs 1 & 2
I had emergency surgery an hour or two after eating breakfast. The anesthesiologist asked what I ate, (McDonald’s) and he told me that they would just pump it out of my stomach. When I woke up after surgery I was famished.
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