Friday, November 24, 2017

The Day Everybody Is A Full Stomach

NPO after MN is not going to help after this meal.
Let's not even pretend that on the day after Thanksgiving people can truly achieve an empty stomach before surgery. Unless the patient had a bowel prep for colon surgery or skipped Thanksgiving dinner completely, there is no way the stomach can have emptied in time by first case of the morning.

Our family changed our holiday meal tradition this year by having a big lunch at a restaurant instead of a homemade dinner. It really is a nice alternative as it frees up the rest of the day to watch football, play outdoors when there is hardly anybody outside which is a rare event in a big city like Los Angeles, or prepare for shopping. Plus the house is not a total disaster afterwards. After over 18 hours since our meal, my stomach still feels full and I have a persistent heartburn that just won't quit.

Now imagine your patient who decided to eat their Thanksgiving dinner and then followed the preop instructions by staying NPO after midnight. With all the meats and fats in the food, there is no way that their stomachs will not still have food inside. If the patient is having a general anesthetic with intubation then it shouldn't be a problem as long as they're done under rapid sequence induction. But for cases where the airway is not protected, such as interventional radiology or cath lab, then I'd be concerned about a high potential for a full stomach.

This raises the question of why surgeons would schedule cases for the day after Thanksgiving. And why would patients want to have surgery on this day? Unless it's an emergency, there doesn't seem to be a good reason to skip a holiday tradition to have an elective operation. It can always wait until next week so patients and their families can enjoy their time together over a long weekend. Why would anybody want to schedule a spine or even a major vascular case for today?

I suppose everybody has different priorities. Some patients just want to get better sooner instead of agonizing over their operations over a holiday weekend while some surgeons need the extra cash for their holiday shopping. Whatever the reason the operating rooms are full today as if this is just another usual Friday. Except on this day most of the patients will have food retained in their stomachs so be careful out there.

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