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
Your stomach and your lungs share the same driveway (your throat). This is both good (saves real estate space) and bad (your stomach contents could end up in your lungs if they decide to reverse out). Stomach contents are pretty acidic and they do some real damage to the lungs if they end up there. Good news is that when you vomit your body does some pretty smart and slick manoeuvres (which I am sure you have realised you have no control over) to make sure your stomach contents end up in the toilet and not in your lungs. Unfortunately when you are deeply unconscious (or under anaesthetic) your body loses the ability to do this.
So anaesthesiologists have come up with some steps to try and prevent this from happening. The most successful step is to starve you for a few hours before your anaesthetic and let your stomach empty itself (in the right direction). This works pretty well when we all know when the surgery is going to be.
However when the surgery is an emergency, we often (not always) can’t wait for the staving period AND the problem you are coming to surgery for often means the normal starving period won’t be long enough to drain your stomach anyway.
So a few smart guys in the 1970s came up with a way around this. Basically they follow a clear sequence of steps, very rapidly, to put you to sleep and place a tube into your windpipe. To be extra safe, they also inflate a ballon attached around the tube to totally block off the lungs from the throat. So now even if your stomach contents decides to reverse out all over the place, it won’t be able to get into your lungs.
At the end of the surgery they will suction your mouth and throat in case there are stomach contents there, deflate the balloon and pull the pipe out.
So why don’t they just do that for everyone? Basically that rapid sleeping method can cause quite a few other problems, like, with your blood flow and oxygen delivery. So if they don’t have to do it, they would rather not.
Last thing: even with all the steps is there still a chance the stomach contents can sneak into the lungs between the time you go under but before the tube is in and the balloon is inflated? Yes. How do they prevent that? They need to be very fast.
I had surgery 3 weeks ago, and the nurse asked me what time I last ate, and the anesthesiologist quickly responded, “actually we’re now learning it’s best to have a light snack before surgery, people do better with nausea from the anesthesia if they’ve eaten.” Some countries have you eat a few bites of pudding and a cup of tea directly before surgery. They wake up easier, and they don’t feel sick afterwards.
I have to have an antinausea sticker placed behind my ear because I wake up and immediately start vomiting after surgery, I have surgery today and I’m going to eat some rice pudding beforehand, I’ll report back if I aspirate.
For emergency surgery they will stick an NG tube up your nose and down throat and pump stomach. 0/10 do not recommend.
Long story short surgery is, at it’s core, a risk benefit decision. In an emergency the risk of aspiration relative to waiting and not performing the surgery favors surgery. In ANY other situation the risk of aspiration relative to waiting and not performing the surgery favors aspiration… so you wait.
In an emergency they do something called rapid sequence intubation. They get everything ready, knock you out, paralyze you, and intubate in rapid succession to minimize the opportunity for stomach contents to come up the esophagus. There is a risk for becoming hypotensive and cardiac incident when doing that, so it’s not favored.
You generally don’t want to break a small child’s ribs but it is an acceptable risk if that child is choking on something.
The reason they have you fast is that under anesthesia food and acid can regurgitate up your throat and you don’t have any reactions in place to keep it out of your lungs, so you could aspirate that food and acid into your lungs, which is obviously very bad news. The less you’ve eaten, the lower the possibility of that happening. So if you know the surgery is coming, it lowers that risk. If you don’t know the surgery is coming, you have to run the risk anyways. It’s like running a sprint. If you know a race is coming, you aren’t going to eat a big meal beforehand. But if you’re being chased by a mugger, you’re gonna sprint anyways even if you just ate a huge meal.
Anesthesiologist here.
We like patients to be optimized. That doesn’t mean 100% healthy or prepared for surgery but it does mean as healthy or as prepared as a person can be. This means limiting risks. There’s a small chance a person will vomit on induction of anesthesia(there’s many reasons why this can happen but beyond the scope of this answer).
When a person vomits there’s a chance the vomit goes into their windpipe and reaches the lungs. This can cause an inflammatory or infectious reaction leading to breathing problems, lung inflammation or pneumonia. The things that cause this problems more are low pH (stomach acid and digestive enzymes) and particulates (food). If you fast you’re less likely to have these in your stomach and less likely to have a bad outcome if you vomit. It doesn’t happen every time but like I said, I want you as safe as possible.
When there’s an emergency we weigh the risk vs benefit. So if you’ve been shot and will die if we don’t operate but have a burger in your stomach I’ll say well some pneumonia is less bad than bleeding to death please operate. But if you’re showing up for a scheduled knee replacement I may say let’s wait for the stomach to empty since this surgery isn’t life or death and I can make you safer for surgery.
It’s all about risk management.
If you come to a broken bridge and you’re confident that you can leap the gap, you probably would.
If I told you there were piranha in the water below, you might not.
But, if you were being chased by a tiger, you might make the leap anyway, because the tiger is a more immediate threat.
I mean, you’d still die, tigers can leap like 35 feet.
So, they minimize the risk in planned surgery by making sure you don’t eat so you don’t aspirated food, get pneumonia and die. But, if you’re going to die anyway, they’ll try to save you and then hope you don’t aspirate food, and if you do, hope they can treat that.
Emergency = you’re probably gunna die soon if they don’t intervene. So if you get pneumonia from puking up and aspirating your biscuits and gravy while they save you’re life, they’ll take the chance and blast you with antibiotics if it happens.
But… in the case of a scheduled procedure or surgery it would be best to avoid the barfing food into your lungs scenario.
Latest Answers