I’m a type 1 diabetic whose surgery got delayed until 2:30 pm for a six hour surgery. Long story short, I woke up in the ICU because of blood glucose issues and terrible OR policy around diabetics in surgery. A reversal of this policy (and treating type 1s differently from type 2s) would make surgery safer and easier on people with my condition.
All these years of dogmatic fasting and I coulda saved that horrible caffeine headache with a cuppa joe morning of surgery? Arghhhh. If you two point toward a RCT study that says bowel preps are unnecessary for colonoscopy, I’m coming after u both after the way too many I’ve had the last 3 years. ;-)
"The surrogate outcomes gastric volume and pH have never been shown to correlate with human anesthesia-related aspiration. [SNIP] Preprocedural fasting might be replaced by bedside gastric ultrasound examination of gastric volume."
Technique X has never worked before so we might want to do more of X. Can you imagine a building contractor writing: crumpled newspapers have never been found to properly insulate a house. We might replace it with wadded up paper towels in the future.
I listened to your discussion with great interest as I think you guys do a great job dissecting and analyzing the examined literature. In looking at this paper I note that in the nine included studies all of the patients in Table 1 had liquids of some sort, mostly clear liquids, or chewed gum to stimulate gastric secretion, in close temporal proximity to anesthesia induction. Table 2 lists studies of residual gastric volume which demonstrate liquids clear the stomach more rapidly than solids. I don't think any patient had a bacon, egg and cheese sandwich within 2 hours of induction. Thus, I find the title of the paper to be a bit misleading. Perhaps "Preprocedural fasting" should have been "Preprocedural drinking".
Despite the evidence through RTCs every doctor will do what he/she thinks is correct. If the patient is asking for X which has been proven to be safe, and the percentage of a negative outcomes vs a positive outcomes mean nothing. The doctor will either say, "no, if I do this procedure I will do it my way" or say, "because you are thinking way out of my comfort zone I believe it would be better if you find a like-minded physician"
I’m a type 1 diabetic whose surgery got delayed until 2:30 pm for a six hour surgery. Long story short, I woke up in the ICU because of blood glucose issues and terrible OR policy around diabetics in surgery. A reversal of this policy (and treating type 1s differently from type 2s) would make surgery safer and easier on people with my condition.
All these years of dogmatic fasting and I coulda saved that horrible caffeine headache with a cuppa joe morning of surgery? Arghhhh. If you two point toward a RCT study that says bowel preps are unnecessary for colonoscopy, I’m coming after u both after the way too many I’ve had the last 3 years. ;-)
"The surrogate outcomes gastric volume and pH have never been shown to correlate with human anesthesia-related aspiration. [SNIP] Preprocedural fasting might be replaced by bedside gastric ultrasound examination of gastric volume."
Technique X has never worked before so we might want to do more of X. Can you imagine a building contractor writing: crumpled newspapers have never been found to properly insulate a house. We might replace it with wadded up paper towels in the future.
I listened to your discussion with great interest as I think you guys do a great job dissecting and analyzing the examined literature. In looking at this paper I note that in the nine included studies all of the patients in Table 1 had liquids of some sort, mostly clear liquids, or chewed gum to stimulate gastric secretion, in close temporal proximity to anesthesia induction. Table 2 lists studies of residual gastric volume which demonstrate liquids clear the stomach more rapidly than solids. I don't think any patient had a bacon, egg and cheese sandwich within 2 hours of induction. Thus, I find the title of the paper to be a bit misleading. Perhaps "Preprocedural fasting" should have been "Preprocedural drinking".
Despite the evidence through RTCs every doctor will do what he/she thinks is correct. If the patient is asking for X which has been proven to be safe, and the percentage of a negative outcomes vs a positive outcomes mean nothing. The doctor will either say, "no, if I do this procedure I will do it my way" or say, "because you are thinking way out of my comfort zone I believe it would be better if you find a like-minded physician"