If you were in a car crash and had been eating all day, how is that different from a routine surgery where you weren’t allowed to eat for a certain amount of time before surgery?
Edit: based on some answers, perhaps I should clarify obviously I understand they have to perform surgery in an emergency. My question is more what do they do in an emergency when you haven’t fasted.
Thanks to those with real answers, I never knew about the special tube that could be used. That’s pretty cool.
I’m having surgery tomorrow and can’t eat so was just wondering how they handle food in the stomach during an emergency surgery situation.
In: 2585
Anaesthetist here.
People eat and breathe through the same hole – mouth/pharynx – which then divides into 2 holes: the esophagus for food, and the trachea for air. If food goes down the trachea, the consequences are bad. Pneumonia, or death. We have very sensitive reflexes to make sure that when we swallow food, the trachea is closed off by a flap called the epiglottis. You can’t swallow and breathe at the same time. Don’t try!
If a tiny bit of food or fluid gets past the epiglottis, your body will try to expel it. You have probably all experienced this when a drop of coffee goes down “the wrong way”, and you cough and splutter to get it out of your lungs.
In anaesthesia, we need to put a plastic tube into the airway, sometimes at the back of the throat, sometimes all the way into trachea. To do that, we need to give very powerful drugs to block those protective reflexes.
Without those airway-protection reflexes, any food in your stomach can come up (regurgitate) and go into your lungs. That food might be half digested, which means there are stomach acids mixed in. Those stomach acids can destroy the lung, and the food particles block the lung passages, stopping air from getting in. If you don’t die straight away from that, that food matter could cause lung infections, pneumonia and death at a later date.
This is why we insist on no food before elective surgery. If you have eaten in the previous 6 hours, we will cancel or postpone your surgery until we are sure your stomach is empty. It’s for safety.
Emergency surgery is different. Sometimes even with urgent surgery, we can afford to wait a few hours to allow the stomach to empty naturally, but sometimes we can’t wait because the surgery is urgent.
In that case, we proceed, despite food in the stomach. It’s a calculated risk. We do what is called a “rapid sequence intubation”. This is a relatively risky technique to put a tube into the trachea quickly. We get everything ready, drugs, equipment, suction, skilled personnel. We give the potent drugs in quick succession (rapid sequence) and in bigger doses so they work quicker, aiming to get the breathing tube in quickly, before any stomach contents can come up and go into the lungs. The tube (an endo-tracheal tube) has an inflatable cuff on the end in the airway. When the tube is in place and the cuff is inflated, the trachea is “secured”. Even if food and acid come up from the stomach, it can’t get past the cuff and can’t get into the lungs.
TL;DR anaesthesia with a full stomach is risky. In elective surgery that risk is unacceptable. In the emergency situation, we may take that risk but use techniques to minimise the risk.
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