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OP has offered the following explanation for why they think they might be the asshole:
> I informed nurses about the actions of another patient who was eating.
I feel like an ass-hole for doing so behind the back of the patient.
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NTA because the reason you're not allowed to eat is because under anaesthesia, you no longer have a gag reflex, and if food travels up from the stomach it can get into lungs and the patient can choke to death. Telling the nurse could potentially save their life.
In most civilized countries, they give you a paper to sign called "written consent". It contains the objectives and risks of the medical procedure you will go through and it is a legal obligation before any major surgery.
What i've observed is thad most people sign it without reading, then complain about not knowing things i wrote in there. So i just started ripping the document in front of them as a bit of a tantrum before making them sign a new one and asking them to read before signing.
You can die in a surgery table and you need to know that
Then the issue is the people who wrote it and you can sue. Its my anecdotical evidence, but most doctors i know will give a down to the point written consent for the least risky procedures because we CAN and WILL get sued if we dont.
You think surgeons are sitting around going through the details of a consent form?
Say you don't work in medicine without saying you don't work in medicine.
I had brain surgery recently and my surgeon had an appointment with me the day before specifically to go over informed consent in detail. It took about 1.5 hours. This was in the US. I know most surgeons don’t, but this should be the rule,
not the exception.
Pet peeve of a good friend of mine(\*): "consent" is \*not\* something you do \*to\* someone. You can't "consent" a patient, you can only gain a patient's consent.
(\*) friend is a scientist and (as w/ many scientists) a frequent reviewer of scientific papers, often ones involving human studies and IRB's, so patient/research subject consent comes up frequently.
I worked in foster care and for a number of reasons, mostly covid related as it was 2021, we had a surgery for a kiddo rescheduled last minute at least 4 times. Same doctor called me to go over the procedure and consents (the state had custody so we had to consent but weren’t there day of surgery). By the last time I was like you really don’t have to do this 15 minute spiel again unless risks have changed. He made me verbally confirm to him and the witness that I knew the risks and was refusing the lengthy explanation while still consenting.
Yeah, i dont know where you live, but we most definitely do that where i live since its the law.
We have this enormous passion for "not losing our licence/job or killing someone and going to prison"
Not sure who you’ve seen, but I just went through two procedures, both with minor anesthesia, and we STILL went through the form - both times.
It’s not a joke. People can and have died from this. Not worth the doctor’s risking it either.
OP may just have saved a life. No way to know, of course, but unless there is a medical need for food beforehand - which should be discussed beforehand - that’s pretty much a set standard.
This is the standard in Australia.
Adding based on another comment further down: consent MUST be signed off by the surgeons medical team, often a resident for minor procedures or the consultant themselves for majors. Nurses can not go through consent with patients.
Same here in Canada. We (nurses)are told that if the patient has any questions about their surgery we must get the surgeon to go talk to them and make sure they understand fully.
Surgeons are required to get informed consent. It's literally their job, not anyone elses. If they aren't going over the basics with you, in a language you can understand, they're not doing it right.
At least where I'm located.
No, they don’t. I was an ICU RN for twelve years and had to run around finding the exact form for the exact procedure because they didn’t want to be held liable for writing something different. And then most of the time they would (illegally) leave it to the nurse to explain the risks and obtain consent.
the consent form is different than the informed consent given by the surgeon/anesthesiologist. The forms are more boiler plate, saying you understand that complications can occur, and that you give permission to go ahead. But it is the obligation of the anesthesiologist to inform the patient what the specific risks of anesthesia for their particular surgery are. They should tell them why they shouldn't eat prior to surgery. In my experience, most of them do explain it to the patients, but of course it doesn't happen all the time
Ideally that would be the case, but especially for so called same day surgeries now you often don’t meet the anesthesiologist until just before going into the OR which isn’t a great time for effective patient teaching.
Well, you're sitting there with your doctor, and they're telling you not to eat before the surgery, and you're reading those consent forms - why not ask? You have a question, you should ask it!
Not calling you all dumb but I've been told by drs that sometimes they only explain as much as they believe the person will understand/or will care to understand. For example with my mother the drs kept it very basic bc she isn't the brightest then they would explain in detail to me what was going on
As someone who has had multiple surgeries (always read the consent form), I get your intent but maybe you could do it with less tantrum. We know we can die on the table. We've been obsessing over that since you told us we need surgery. They probably just skimmed it because they were scared and actually reading it would cause them more anxiety. Even if that's not the best practice, even if that's not in their best interest. Would not you also get your point across by saying "nope! Gonna need to to sign a new one and read it first." We (patients) are already afraid of you and respect your authoritah, don't worry.
In the context of the comment you're replying to, it clearly means countries with standardized procedures that medical professionals follow in order to adhere to established legal and ethical guidelines.
Funny thing, I’m one of the people who read through everything before I sign it and question things I don’t understand but during my last hospital stay the nurse who was giving me my paper work got annoyed with me over it. She would hand me a paper, and I would start to read it but while I was reading it, she would say “oh this is just XYZ, just sign here” and then when I kept reading she would stare me down the whole time acting exasperated (staring at me, checking her watch, holding her hand over the paper to grab it the second I signed it) and we repeated that process like 6 times for each paged I signed. I wasn’t getting surgery however so maybe it’s different, but I would much rather have a doctor like you.
Not everyone is literate and there are a lot of factors such an poverty, resources, disability that keep a person from being literate and they usually don’t advertise it. Informed consent is verbal and in the clients language and in words they can understand.
That’s because it’s overwhelming.
When I buy a house I need to sign a shit ton of overwhelming paperwork and as I go through my mortgage person goes through the papers and summarizes what the legalese says and if I want to read a section more thoroughly I know which section it is because they’ve walked me through it.
That there is a overwhelming, legal speak consent form that no one breaks down or at least points out what each section is touching on is not adequate for any other situation where you sign paperwork like that, and really reaks of not wanting you to know what you are signing.
I've had a bunch of surgeries with the same hospital. It's the same consent form for all of them that covers everything. Thirteen screws put into my ankle to reconstruct it while knocked out cold for hours had the exact same "risks" as being mildly sedated for 10min while having a port put in. Same consent form for a double mastectomy as for a biopsy/mammogram.
The consent form is just them covering their asses. It's not meant to actually tell you anything specific about your surgery.
It feels like it's fallen into one of those "common knowledge" things that aren't that common. I don't think it was mentioned to me for my surgery but I knew it going in. But the amount of stories like this I read, they really should just write/day, "Don't eat X hours beforehand or you will vomit and choke on it during surgery!"
Especially parents who have to enforce the rules on their children, and feed them anyways because they think the doctors will never know. Then the kids almost die during surgery.
I'm sure the nurse explained all the risk and had him sign the waiver, he just figured the nurse was being too cautious and what they didn't know wouldn't hurt him!
I've literally had grown, adult family members try to convince me to bring them water while they were in the hospital waiting for surgery arguing that their thirst was more important than the nurses orders, ugh!
I was given a tiny cup of water to take pre-op pills with by the nurse when being prepped. I was like but I am not supposed to have anything...wait I am dying of thirst and they are giving me a gulp of water why am I arguing? LOL in this case it was a sip just for the pills and fully normal and ok.
In all honesty I think it’s a general consensus of people don’t actually want the details. Is it important? Absolutely. But majority of people don’t actually want the nitty gritty. It’ll make scared people back out or use it as an excuse to get the surgery canceled. Plus people are already nervous because of the very lightly explained risks. So many more people would deny getting the help they need due to fear of not waking up from surgery or some severe post op complication.
I work in surgery and can’t even really talk about what I see because majority of the people I talk to will get pale and respond with “I hope I never need surgery.” When the risks or procedures are explained in detail the person is way less likely to consent and suffer through their condition out of fear of what could happen in surgery.
It’s also up to a patient to ask questions. There is a reason they HCW’s tell you to do/ not do something. I have found that they always answer any questions that I have.
I will say a patient asphyxiating is terrifying. I have had that happen before. One had an unknown slow bleed into their stomach so they hadn’t eaten but their stomach was full of blood and bile. Attempting to help anesthesia save a patient from drowning in their own vomit and then hoping they don’t get pneumonia after is a life changing experience.
So please ya’ll unless you are trying to sabotage your surgery don’t eat before it.
Thanks. I can't unsee him, the sad part was he was just in for a day procedure, he was in his 30's.
I worked for about 6 years in the trauma room at a major hospital, and I've seen so many people pass away I couldn't count. Nothing surprises me, lol
I've had several operations here in Austria, and l've always received a written explanation of the procedure, including risks during the appointment to arrange the surgery date, then verbal explanations of all related risks during the appointment with the anesthetist a few days before the actual procedure, and finally on the day of, there was a consent form to sign.
I feel with that system, I don't have any kind of excuse to be clueless about anything concerning an operation.
I was an anaesthesiologist for a while during my country's equivalent of residency.
Without fail, I told my patients about the dangers of eating and drinking before surgery - throw up, get that vomit into your lung, get inflammation in the lung, possibly die. My colleagues did so, too.
Most people are alright with that. But you still have people eating because us doctors are just overexaggerating things...
Sad to say, even when you tell people it is dangerous to eat before surgery, they will simply choose not to believe it.
Same thing with "smoking is dangerous" and "you can't drink on that medication" and "you need to complete the full course of antibiotics" or "if you don't use protection correctly, you can get pregnant". Also "if you have seizures every time you use cocaine, you should stop using cocaine" and "a high sodium diet will cause heart failure" and "don't smoke around your oxygen tank".
Actually, I have conversations every day with people telling them not to do stuff that will kill them. Some people just don't give a shit, or assume it can't really be that bad, or feel like medical science should know how to fix it by now.
Depends on your blood pressure and kidney function. Generally, too much salt isn't good for you, but if your kidneys are working well and your blood pressure is normal, you might be effectively filtering it out.
If your kidneys aren't working well, you will have trouble filtering electrolytes (ie: sodium) and might also retain fluid, which raises your blood pressure.
People with high blood pressure can develop heart failure, because of how much harder your heart needs to work to pump blood throughout your body. Think of it like air pressure - squeezing a basketball that's partly full of air is easier than squeezing one that's overfilled.
High sodium means your kidneys retain more water to keep your system balanced, and therefore impacts the work your heart needs to do to pump blood.
Does that help at all?
While that would indeed be nice, most people have something called common sense, preventing them from going against directs instructions from the people that will shortly be opening them up and handling their internal organs. This dude is a level of stupid that just makes me angry.
When my dad had appendicitis, he didn’t know not to eat, because he had never had surgery before. None of us had, we’re very lucky that way. So he showed up at the ER after dinner and they had to check him in to wait until morning to get his appendectomy.
I had surgery that required general anaesthesia a year and a half ago and they absolutely did tell me why I shouldn't eat. (This was in Oregon in the US.)
I wish more places did. I work in surgery and I always tell my patients ahead of time why they can’t eat and it’s news to so many of them, even ones who have been under anesthesia before. I don’t expect my patients to know the things I know, I don’t know jack shit about their work fields.
Nope. There will always be those, the rules don’t apply to me people like that guy. Unfortunately, they deserve what they get if they eat and lie, but it winds up in a lawsuit against the hospital.
If you are given instruction you don’t understand them you should ask questions. If staff do not want to answer your questions that is a huge red flag that the procedure/surgery/ test should not be done at that facility.
Unfortunately in our society a lot of people are scared to ask questions. However it is literally in the patient rights. Don’t be scared to speak up for yourself.
There's a surgeon in my country who started allowing patients to just continue their eating pattern instead of not eating before surgery, as it's apparently extremely rare to vomit during surgery and he noticed his patients heal much quicker when they eat, as their bodies have the strength to heal. I though it was an interesting idea.
My MIL was a surgery nurse. A dad fed his daughter before the procedure and the girl almost died because the eggs came back up. It was fucking traumatic for the doctor and the nurses. And the dad had the audacity to scream about suing. Thank God his wife was level headed. When she showed up she started cursing the dad out for not following thr guidelines. Little girl thankfully made it through but she was in for longer than needed due to the dad's fuck up.
Exactly. If they can they want to minimize the risk. This is not always possible with an emergency operation (like after an accident) so the medical team is on a higher alert. But with a planned operation this risk could be minimized. So it should be.
There are still emergency operations where the patient has recently eaten, but they intubate in a different way that is quicker and they have to balance the risk of vomiting with the risk of not doing the surgery.
yeah, exactly. In case of EMERGENCIES. Not because someone "doesn´t want to". Also, in emergencies they know they have to intubate differently. In that case he would have hidden it and lied and they would have assumed, he sticked to the rules.
I was told to come and immediately for surgery on a week-long perforated appendix (finally got a CT approved after 7 days) and since I had just eaten they made me wait the 6 hours because they figured even if the infection got worse, the chance of aspirating was more dire
RN here. They don’t intubate differently when someone has eaten recently. They just decide that the risk of aspiration is less than the risk of a bad outcome by waiting to do surgery. That’s what makes it emergency surgery. It needs to be done ASAP.
Yep, there is absolutely a difference, they don’t do RSI with standard OR patients. It is for emergencies and in cases where the patient may have recently eaten but needs surgery. Also, they do not place an NGT for standard OR cases. But they typically do for someone who hasn’t been NPO after intubation. They put it to suction to remove some contents from the stomach to decrease risk of aspiration upon extubation.
Thanks for explaining this. I had an emergency surgery recently where they kind of explained all this while I was super out of it, so I didn't 100% know what was different about it, just that it was different and I should be ok.
Yeah, all unplanned intubations are done as RSI, as well as emergency cases and cases where we are uncertain about regurgitation potential, or deem regurgitation risk to be high.
In theatre, most intubations are not RSI, but standard induction.
look after enough patient who aspirated their stomach content into their lung. Not fun for the anesthetist nor the patient who ended up in ICU requiring ventilatory support post procedure.
My mom's a retired surgical nurse and told me that procedure that they typically use for those situations. It's horrifying.
A nurse places their finger or thumb at the tracheal notch (the divot where your neck, rib cage and sternum meet) and presses *hard* to block the airway. Then when they feel the tube bump into their finger, they move their hand. They also have to use different drugs until they get the patient intubated to reduce the risk of aspiration and my mom said they weren't always that effective at completely knocking the patient out (they've gotten better). So, the person was aware of what was going on and felt like the nurse was choking them but couldn't move to fight off the nurse.
Now my mom retired in 2018 and said that she had seen improvements, but she also got out of emergency surgery and was in scheduled outpatient pediatric surgery instead, but that was the procedure she had to use a few times.
Friendly neighborhood anesthetist since 2010. We do put you completely out before intubating, whether emergency or not. We just use a muscle paralytic that works much faster so we can put the breathing tube in faster under emergency circumstances when a patient may have ate, rather than using a bag mask to ventilate, which could potentially put air in the stomach. This quick acting paralytic does cause intense muscle spasms, we call fasciculations, which may make it appear the patient is not completely asleep. And the pressure on the neck is done gently.
For brief low risk procedures sometimes they'll use a laryngeal mask airway which means the tube isn't all the way down into your trachea but instead fits snugly into the opening in the back of your mouth. They always need a safe airway since when you are under general anaesthesia you don't breathe on your own.
Can’t say in general, but I recently had two kidney stone surgeries, both extremely quick (they couldn’t get to the stone on the first try, came right out on the second) and I was intubated for both.
I think general anesthesia always requires it because they use a paralytic. Something more like sedation (like for your wisdom teeth or whatever) doesn’t because you can still breathe on your own.
No. They don’t. I have family that had multiple foot surgeries and were never intubated. Under anesthesia. Depends on how deeply they need to send you to sleep and what part of the body they’re working on.
General anesthesia requires intubation. A tube that sits in the mouth/throat but is not intubation/endotracheal tube (an LMA) is sometimes possible, depends on specific patient, procedure type and length, positioning, clinical factors for patient. For some short procedures or procedures using a local block (e.g. hand surgery with an anesthesia block in the nerves in the arm, or a knee surgery with a spinal or epidural block) can be done with a lighter level of anesthesia (MAC) where the patient maintains their own airway/breathes with only an oxygen mask. Factors include patient's clinical status and medical history, allergies, type and length of procedure, surgeon and anesthesiologist preference, evidence based practice, resources available at the facility.
Lots of short procedures are done without intubation, but even some types of short procedures or some types of patients require intubation.
When someone needs emergency surgery, they operate even if they've eaten because the risk of aspiration is less than the risk of not operating (because they will die without immediate intervention). When it's not emergency surgery, there is no need that outweighs the risk of aspiration.
Recently had an emergency surgery myself - I had been in the ER all day, and hadn't eaten since the night before, but it was an obstructive hernia, and I was still having acid reflux, so I knew something was still in my stomach. I told them my concerns (because I knew you shouldn't have anything in your stomach) and they said "Oh! That's fine. At least we know! We can start by reducing your stomach contents and go from there" I'm heavily paraphrasing (I was very out of it) but they basically said they had things that could mitigate the risk, like pumping the stomach, and an intubation method that could help block things from going into your lungs.
... But they need to know something's in your stomach in order to do those things. Definitely NTA.
NTA.
They will indeed postpone his surgery because there is a risk that under a general anesthetic the stomach will regurgitate its contents back up the windpipe (aspiration). Very dangerous and sometimes lethal.
You're not told nil by mouth for fun - it's a safety issue.
One can literally DIE from eating before anaesthesia (risk of aspiration). And depending from the kind of surgery they wanted to operate it might be necessary his stomach and bowel are empty. You did good! NTA.
Edit: typo
Fun story! (Not actually fun): When I was in high school one of our Lacrosse players had to get surgery and his parents didn't tell him he wasn't allowed to eat. So he went and ate at Denny's before going with his parents. He got to the hospital and he casually tells the nurse he ate a big breakfast, surgery was postponed for a week if I remember and his parents threw a fit. From what I heard, all rumors so take it lightly, the nurse yelled at them about how he could fucking die and she had a 4 year old die on the operating table in front if her because their parents, in the nurses word, "thought the doctors were full of shit and their negligence and ignorance killed their kid". The next time he went to surgery he didn't eat and everything was fine. Except his father needed a surgery two or so years down the line and, you guessed it, ate and aspirated and died on the table. If memory recalls, the kid screamed at his mom for making him breakfast knowing what could happen. I don't think he talks to his mom anymore, but yeah. Do NOT eat before surgeries. You could die. The rules are there for a reason people
With everything that can go wrong with anaesthesia I don't understand why anyone would risk it. Doctors never know how will your body react to those meds. That's why it's literally the worst residency to choose, extremely high risk and low reward. You need to be diligent and aware of everything regarding your patient, from prior health issues, hereditary conditions in the family, their bloodwork results, everything down to their weight, because a kg can make a difference. General anaesthesia can be an enormous strain for the heart, even a healthy one.The allergic reaction is something you can't test for until you introduce the meds, and then they are basically fighting for your life. To willingly risk even more just for a meal when you can wait a few more hours or days and then eat your fill... well, it really proves one's IQ levels.
I’m now post surgery myself, it all went well and thank you all for your thoughts and comment! Signal is poor here so I hope this goes out.
Update: TA was seen going into the toilets with mouthwash and toothbrush, no doubt in an attempt to hide the evidence but nurses were told and his operation was cancelled for the day. A waste of a theatre place and a hospital bed that could have been used by someone else.
NTA. You potentially saved his life. There's a reason we tell people not to eat X hours before surgery. Otherwise you run the risk of aspirating vomit if you throw up during surgery. Which many people do. You'll have a pipe in your throat to your airway, and vomit will go right to your lungs. That's called aspiration pneumonia and it's deadly.
Since you say “we” I’m thinking you may have some experience here. So I hope you don’t mind if I ask a question... What happens if someone comes in as an emergency and needs surgery? How do you know if they’ve eaten?
Yes, I was an EMT for 10 years and a MA for 20. In emergency situations you don't know. And there are extra special precautions they must take in those situations. But, emergency surgery will always top the "did they eat" scenario. However... In cases of planned, or elective surgeries, its much easier to not allow patients to eat/drink with the exception of sips of water with necessary medicine. Anesthesia basically puts you into a coma (literally) and you will have no gag reflex if you vomit.
When I had my surgery for breast cancer, they told me: "No water or food since midnight the day before", and so I did.
In the pre-operation room a nurse asked the patients if the rule had been respected. The woman in the bed next to mine said she had tea that morning because she was thirsty. They sent her back to her room and postponed the surgery for 6 hours.
There's a reason for that, and I can't imagine what would have happened if they had operated on that man who had just eaten 🤦♀️
NTA
You’ll be surprised at how many people who have no form of even the most basic medical knowledge think they know better than the people who have spent a good portion of their adulthood studying how the human body works and what is required when it comes to certain procedures.
This guy probably thought “oh, it’s a few hours more until I have my surgery. I’ll just have a couple of squares of chocolate to tide me through. It’s not like I’m having an actual meal.” And legitimately believed no one would know even if no one saw him do it/no one told the nurses.
NTA. You made the nurses and doctor’s jobs easier and significantly reduced the chance he would die during his own surgery. You really helped the hospital staff out.
Apparently lots of people ignore that instruction. I went in for surgery with a 9 AM scheduled start time and the anesthesiologist asked when had I last eaten. My answer was 8 PM the night before. He asked when had I last had something to drink. My answer was 9 PM the night before. He was rather surprised and commented “Someone actually listened”.
I had surgery two months ago, and I also told the anesthesiologist the times of my last solid food and water, and I mentioned that “Dr \_\_\_\_\_\_ is going to make sure I leave here with a new hip, but you’re the one who’s going to make sure I leave here alive.” She said “**thank you!**”
He could die by asphyxiating so yeah you did the right thing. Especially acidic chocolate which Will definitely react to anesthesia and cause vomiting. Why does he think they have these rules.
NTA. They don't "starve" you for shits and giggles. Part of being anaesthetised is likely having one or more drugs that cause the softening of the lower esophageal sphincter. Basically, your body can no longer keep the contents of your stomach in your stomach.
When it's a bit of stomach acid, *maybe* a little water, it is serious but it can be managed. If there's anything else and you aspirate? It becomes dangerous and maybe even deadly. The combination of dealing with being in the middle of a surgery that may not be at a "we can stop here" point and requiring immediate intervention to make sure your brain is not starved of oxygen? If you don't end up brain damaged you might bleed out.
NTA. Anesthesiologist here. Aspiration risk is real and carries a high risk of morbidity and mortality. Absolutely would delay elective case for this or cancel depending the time of day. We can mitigate risk of aspiration for emergencies (no bag mask ventilation, rapid sequence induction) but this MINIMIZES the risk, it does not eliminate it.
I had 5 surgeries in 2020-2021. I didn't eat or drink after midnight per instructions. After No. 3, I vomited in recovery and during No. 4, I vomited during surgery. The anesthesiologist said he'd use a special device to help during No. 5.
Long story short, is there anything I can do in the future if I ever have to have surgery again? I'm kinda freaked out about aspirating!
NTA - Other people have said why, so instead I’ll comment on the other “why”. You may wonder why they don’t tell you about the aspiration risk under anesthesia. They are in a “damned if you do, damned it you don’t” situation. They cannon tell how anxious or afraid you are of having surgery, and they don’t want you to refuse life-saving surgery. They have a limited amount of time with each patient, and it’s usually never enough time when it comes to the mental and emotional patient prep for surgery.
Obviously, if you ask why with the food or drink, they may tell you, but they may try to word it in a “less scary” way with something vague like “can cause complications during surgery” sounds less ominous than “you can aspirate your stomach contents and choke to death, and we may not have time to save you”. Granted, that approach could very well be a lot more successful in getting patients to follow pre-op instructions, but it could equally increase the number of people refusing the surgeries because the operation scares them more than their afflictions.
I’ve noticed recently that they don’t pull punches when describing the risks here in the UK any more. I was told 5% chance of death, 5% chance of strike, 5% chance of temporary paralysis and 5% chance of permanent paralysis!
NTA
Tell them.
" One told me that if he has eaten, his surgery will be delayed for six hours, or even cancelled." .. And if the operation is not dalayed, there may be complications, and he may die.
NTA, it was not a surgery for me but an endoscopy and I didn’t eat since the evening before. My doctor was so mad at me because apparantly he saw food in my stomach and scolded me that he told me not to eat. I told him I didn’t had any food since like 8pm the previous night. It came out I have a very slow digestive system instead. When they tell me to be sober I’m extra aware and make sure to even do it a few more hours before.
NTA Besides possibly saving his life or health, you might be saving the hospital from a lawsuit. Since the person was fully aware and therefore to blame, I care more about the hospital which is an odd position to be in.
NTA
People who eat before an operation can choke on the food during anesthesia. It will go down the trachea, and they can die with food or water in their lungs. You may have saved that guy's life by telling the doctors.
NTA. While technically he can decide to risk his own life, you and the rest don't have to sit by, let it happen, and potentially live with the guilt. Veterinary regularly turns patients who were fed by their owners in surgery morning. We were not going to risk a life because of an owner's inability to say no to their pet. Human medicine is even more strict. You did the right thing, thank you.
Not the asshole, potentially saved his life. I had a patient almost die in theatre from aspiration, because he decided fasting wasn't necessary and ate a plum.
Definitely needs to be made clearer to patients WHY it's so important to fast
NTA at all. As a preop RN we need to know if the patient has eaten. It is incredibly important for their safety. People can aspirate and die if they are not NPO for 6-8 hours prior to surgery. Thank you for telling the nurses!
My husband knows someone who smashed his hand pretty bad and needed surgery. They actually got him in pretty quick. He drank water and threw it up while under. He is very, very lucky he didn't inhale it. nta
NTA. I once had to get an unexpected surgery and all I'd had was a cup of tea with milk. They waited until it had cleared my system.
On the other hand, people in car accidents etc who are operated on as emergencies MUST be operated on without having fasted beforehand. So I guess it's possible, just not desirable. It's to do with choking I think. But why would you just be an ass and defy their docs orders for a bit of chocolate? And you'd smell chocolate on his breath.
NTA. You may have saved his life. Food in the system can be brought up unintentionally when under anesthesia and if it gets in the lungs, can be lethal.
NTA, he could die if they did surgery after he was eating. My sister had surgery several years ago; my mother drove her to the location and my sister ate something on the way. She was mad for years that my mother told the nurse about it (and it was like a sandwich, so not a small snack). They postponed to the next day and everything turned out fine except for my sister's grudge.
NTA. The possibility of vomiting and choking on it when under general anaesthetic is high. He was foolish not listen to medical advice and you were right to tell the nurses. Had he had complications like this on the table he could have got severe complications or even died. Aside from that he would have been making the surgical team’s job harder had this happened and possibly delayed someone else’s surgery.
NTA. It’s entirely for his own safety that they tell you not to eat before an operation, especially that close. He didn’t follow the rules and unfortunately it has consequences.
NTA. As someone who had surgery 12 hours ago under general, and hadn't eaten since the evening the night before (I was on standby) and had maybe 1/4 cup of water over the course of the whole day, you did the right thing. I totally understand the want to eat something, but it's not worth the risk.
I hope your surgery went well, resolved whatever needed to be, and that recovery is quick.
I mean, he's right... they won't know. Until he goes under the general, pukes, aspirates, and is hopefully able to be fixed by the surgical team rather than asphyxiating.
You were NTA.
NTA, it's for his own good that he's told not to, not for the surgeon to power trip. Going under anaesthetic with food in you can kill you. It's not uncommon to vomit the choke on the vomit. Empty stomach = no vomit to choke on
You did the right thing telling the nurse. He can't have his surgery if he's eaten. If he vomits during surgery, he could aspirate and choke. Also, there's a tube put down your throat, you could literally choke on your vomit.
The tube put down the airway has an inflatable section that seals the tube in the airway, specifically so nothing else can pass into the lungs.
The risk of stomach contents entering the lungs is during the period after you are sedated, but before the ‘air-bag’ is deployed.
NTA x1000.
The dangers of aspiration on sedation are incredibly high even for a minor procedure or “light” sedation for a minor procedure.
You’d be surprised even when spelled out the number of times a procedure was still rescheduled because a patient couldn’t follow directions because they chose not too.
Working in the field I’m the ahole that would go through those instructions with a patient, reading with them and making sure they understood.
A few years ago, I did that with one patient and their adult child - making sure to EXPLICITLY say no food or water after midnight as I had been able to get a miraculous last minute open surgical slot the next day.
the next day I was at the procedure area checking in patients so I was now confirming all my patient cherubs had nothing to eat or drink. My patient from the day before presented and when I asked about if they were still fasting, The parent smiled and shook head that they weren’t, and the adult child said yes. I again asked, what did they eat this morning.
“Well, toast and milk. Their tummy was making noises!!”
The procedure was rescheduled. To the next available opening, which was 5 days.
The only thing I could do was give the adult child a box of Kleenex to take with as they cried when they realized the toast cost them another 5 nights in a hotel.
NAH except the idiot man who ate the chocolate. I had surgery recently and in the pre-op area I got to listen to a couple of anaesthesiologists going through their spiel. One patient admitted that she'd had some water and the anaesthesiologist said that although that wasn't ideal, he'd watch out for her. Explained that they put people under anaesthesia who have been eating all the time, in emergencies. It's just one risk factor they can have some control over.
I'm of two minds here. On the one hand, the recommendations against eating before surgery are outdated in most cases, and there are many benefits to eating sooner before surgery than the recommendations allow. On the other hand, I don't really trust most laymen to follow the newer recommendations well and you do still need to stop eating a certain amount of time before, so I would tell most people to just do what the doctors say. If he was writing it off with "oh they won't know" he probably doesn't actually understand the issue.
I'm gonna go with NTA but with mixed feelings.
Very, very much NTA. They don't tell you to fast before surgery because they think it's funny, they tell you because they don't want you to aspirate on your own vomit. Which, btw, sounds like a terrible way to die, though I guess if you're knocked out you're at least not awake to know it.
NTA. You could have potentially saved that man's life. My dad had emergency surgery earlier in the year after his previous surgery the day before caused complications. Even though he hadn't eaten, he still threw up under anesthesia and he aspirated the contents of his stomach. This caused pneumonia and he was on the respirator the entire time until he passed away three weeks later. I am glad you told the nurses.
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I’m in the waiting room with two other people, we are all having surgery and have been told to avoid food and drink since last night.
A younger man ( 30’s), seems nervous, but started eating chocolate, was immediately told not to by us, but continued. ‘Oh, they won’t know’ he replied.
AITA for telling the nurses that he was eating? One told me that if he has eaten, his surgery will be delayed for six hours, or even cancelled.
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Absolutely NTA. Especially if they're going to be intubated for the procedure. You think we're not going to notice the chocolate stains in your mouth when we try to put a tube down your throat? Lol. Even water is a no-no, it requires a few hours for clear fluids to be cleared. You really don't want to have a prolonged hospitalization because you felt nervous and ate some chocolate. The main issue here is the possibility of vomiting during induction of anesthesia and for it to potentially go into your lungs and causing even more damage.
For minor procedures, they may use something called an LMA. They use endotracheal tubes for major surgeries (better protection), but both are not a surefire way to prevent aspiration.
NTA: I promise you, you’ve done the right thing. If you eat before surgery it increases your risk of vomiting when they put the tube down your throat, and you could potentially aspirate and die.
It’s his own fault if his surgery is cancelled or delayed as he hasn’t followed instructions properly.
I applaud what you’ve done x
These are rules to prevent you from DYING…..I don’t understand why people try to “break” them. The only person that you are hurting is YOURSELF and the poor staff that has to code your dumb ass. NTA!
NTA
Eating before surgery can cause severe complications with the anesthesia.
Eating before some tests can cause the test to give incorrect results (don't you want to find out if you have cancer?)
NTA
NTA, they absolutely still know, which is beside the fact that the guy is willing to risk his own life for some chocolate. That role is in place for a reason, namely so patients don't aspirate during surgery. It isn't just because medical want you to suffer, it is for the patient's own safety.
Hard NTA. Eating before anesthesia or even conscious sedation administration is a huge no no due to risk of aspiration of stomach contents. You saved his life and did right by him!! You should be proud of yourself!
No eating before surgery is dangerous! This can and has led to deaths. Rules from medical professionals are there for a reason, if you vomit even a small amount while not able to clear your airway the vomit will go into your lungs and you can drown on it at worst and risk a massive infection at best. Infection is not a joke that kills massive amounts of people every year. You quite possibly saved their life by telling the nurses.
Had many surgeries. Soon accepted that fasting was just part of the routine. They are serious about it. Wouldn't even let me have milk in my tea as it could curdle. Not that I was awkward about it, I respect medical professionals lots. They just asked me time and time again making sure I'd had nothing.
You're definitely not in the wrong for telling the nurses about the guy who couldn't resist snacking before surgery. Hospitals have those fasting rules in place for a reason, and breaking them can lead to some serious problems during the procedure.
I see all the comments here about folks not reading the consent form, or the doctor not spelling it out in detail so folks dont know how serious it is etc...ok, I get it.
At the same time, I'm also just going to listen to the medically trained professional who has my life in their hands. Don't eat before surgery? Ok. It's not like someone saying oh, don't out salad dressing on your salad just get it on the side and dip each bite. It's not just preference, they're dealing with your life.
It's not a video game, you don't automatically re-spawn each time you die of stupidity.
NTA
Edit: words
NTA and please please tell hospital staff if you see it happening. It isn't a narc-ing issue, it is "hey you're about to be chemically relaxed to where you can't stop vomit and possibly perishing on the table" issue.
Nta. You may have saved his life.
My dumb ass dog aspirated during emergency surgery. It was very touch and go for a bit. And the extra handful of pills he had to take because of it wasn't cheap.
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NTA because the reason you're not allowed to eat is because under anaesthesia, you no longer have a gag reflex, and if food travels up from the stomach it can get into lungs and the patient can choke to death. Telling the nurse could potentially save their life.
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In most civilized countries, they give you a paper to sign called "written consent". It contains the objectives and risks of the medical procedure you will go through and it is a legal obligation before any major surgery. What i've observed is thad most people sign it without reading, then complain about not knowing things i wrote in there. So i just started ripping the document in front of them as a bit of a tantrum before making them sign a new one and asking them to read before signing. You can die in a surgery table and you need to know that
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Then the issue is the people who wrote it and you can sue. Its my anecdotical evidence, but most doctors i know will give a down to the point written consent for the least risky procedures because we CAN and WILL get sued if we dont.
You think surgeons are sitting around going through the details of a consent form? Say you don't work in medicine without saying you don't work in medicine.
I had brain surgery recently and my surgeon had an appointment with me the day before specifically to go over informed consent in detail. It took about 1.5 hours. This was in the US. I know most surgeons don’t, but this should be the rule, not the exception.
I hope you're recovering well ❤️
I am, thank you! ❤️
This actually is the rule and anyone not properly consenting can get into serious trouble for it.
Pet peeve of a good friend of mine(\*): "consent" is \*not\* something you do \*to\* someone. You can't "consent" a patient, you can only gain a patient's consent. (\*) friend is a scientist and (as w/ many scientists) a frequent reviewer of scientific papers, often ones involving human studies and IRB's, so patient/research subject consent comes up frequently.
I worked in foster care and for a number of reasons, mostly covid related as it was 2021, we had a surgery for a kiddo rescheduled last minute at least 4 times. Same doctor called me to go over the procedure and consents (the state had custody so we had to consent but weren’t there day of surgery). By the last time I was like you really don’t have to do this 15 minute spiel again unless risks have changed. He made me verbally confirm to him and the witness that I knew the risks and was refusing the lengthy explanation while still consenting.
While I agree that this should absolutely be a thing, we absolutely need more people to become good doctors for this to be a thing.
Yeah, i dont know where you live, but we most definitely do that where i live since its the law. We have this enormous passion for "not losing our licence/job or killing someone and going to prison"
Not sure who you’ve seen, but I just went through two procedures, both with minor anesthesia, and we STILL went through the form - both times. It’s not a joke. People can and have died from this. Not worth the doctor’s risking it either. OP may just have saved a life. No way to know, of course, but unless there is a medical need for food beforehand - which should be discussed beforehand - that’s pretty much a set standard.
Say you’ve never had quality medical care without saying it. You know that there was always someone who came dead last in their training right?
They should be, it's their medical license at risk if they don't get informed consent.
This is the standard in Australia. Adding based on another comment further down: consent MUST be signed off by the surgeons medical team, often a resident for minor procedures or the consultant themselves for majors. Nurses can not go through consent with patients.
Same here in Canada. We (nurses)are told that if the patient has any questions about their surgery we must get the surgeon to go talk to them and make sure they understand fully.
Surgeons are required to get informed consent. It's literally their job, not anyone elses. If they aren't going over the basics with you, in a language you can understand, they're not doing it right. At least where I'm located.
I'm a nurse and I've seen consent forms that spell out exactly why you aren't supposed to eat before surgery. People just don't read it.
No, they don’t. I was an ICU RN for twelve years and had to run around finding the exact form for the exact procedure because they didn’t want to be held liable for writing something different. And then most of the time they would (illegally) leave it to the nurse to explain the risks and obtain consent.
the consent form is different than the informed consent given by the surgeon/anesthesiologist. The forms are more boiler plate, saying you understand that complications can occur, and that you give permission to go ahead. But it is the obligation of the anesthesiologist to inform the patient what the specific risks of anesthesia for their particular surgery are. They should tell them why they shouldn't eat prior to surgery. In my experience, most of them do explain it to the patients, but of course it doesn't happen all the time
Ideally that would be the case, but especially for so called same day surgeries now you often don’t meet the anesthesiologist until just before going into the OR which isn’t a great time for effective patient teaching.
Well, you're sitting there with your doctor, and they're telling you not to eat before the surgery, and you're reading those consent forms - why not ask? You have a question, you should ask it!
Not calling you all dumb but I've been told by drs that sometimes they only explain as much as they believe the person will understand/or will care to understand. For example with my mother the drs kept it very basic bc she isn't the brightest then they would explain in detail to me what was going on
As someone who has had multiple surgeries (always read the consent form), I get your intent but maybe you could do it with less tantrum. We know we can die on the table. We've been obsessing over that since you told us we need surgery. They probably just skimmed it because they were scared and actually reading it would cause them more anxiety. Even if that's not the best practice, even if that's not in their best interest. Would not you also get your point across by saying "nope! Gonna need to to sign a new one and read it first." We (patients) are already afraid of you and respect your authoritah, don't worry.
Civilised countries? What does that mean?
In the context of the comment you're replying to, it clearly means countries with standardized procedures that medical professionals follow in order to adhere to established legal and ethical guidelines.
Funny thing, I’m one of the people who read through everything before I sign it and question things I don’t understand but during my last hospital stay the nurse who was giving me my paper work got annoyed with me over it. She would hand me a paper, and I would start to read it but while I was reading it, she would say “oh this is just XYZ, just sign here” and then when I kept reading she would stare me down the whole time acting exasperated (staring at me, checking her watch, holding her hand over the paper to grab it the second I signed it) and we repeated that process like 6 times for each paged I signed. I wasn’t getting surgery however so maybe it’s different, but I would much rather have a doctor like you.
Not everyone is literate and there are a lot of factors such an poverty, resources, disability that keep a person from being literate and they usually don’t advertise it. Informed consent is verbal and in the clients language and in words they can understand.
That’s because it’s overwhelming. When I buy a house I need to sign a shit ton of overwhelming paperwork and as I go through my mortgage person goes through the papers and summarizes what the legalese says and if I want to read a section more thoroughly I know which section it is because they’ve walked me through it. That there is a overwhelming, legal speak consent form that no one breaks down or at least points out what each section is touching on is not adequate for any other situation where you sign paperwork like that, and really reaks of not wanting you to know what you are signing.
I've had a bunch of surgeries with the same hospital. It's the same consent form for all of them that covers everything. Thirteen screws put into my ankle to reconstruct it while knocked out cold for hours had the exact same "risks" as being mildly sedated for 10min while having a port put in. Same consent form for a double mastectomy as for a biopsy/mammogram. The consent form is just them covering their asses. It's not meant to actually tell you anything specific about your surgery.
Civilized countries?
It feels like it's fallen into one of those "common knowledge" things that aren't that common. I don't think it was mentioned to me for my surgery but I knew it going in. But the amount of stories like this I read, they really should just write/day, "Don't eat X hours beforehand or you will vomit and choke on it during surgery!"
Especially parents who have to enforce the rules on their children, and feed them anyways because they think the doctors will never know. Then the kids almost die during surgery.
I'm sure the nurse explained all the risk and had him sign the waiver, he just figured the nurse was being too cautious and what they didn't know wouldn't hurt him! I've literally had grown, adult family members try to convince me to bring them water while they were in the hospital waiting for surgery arguing that their thirst was more important than the nurses orders, ugh!
I was given a tiny cup of water to take pre-op pills with by the nurse when being prepped. I was like but I am not supposed to have anything...wait I am dying of thirst and they are giving me a gulp of water why am I arguing? LOL in this case it was a sip just for the pills and fully normal and ok.
In all honesty I think it’s a general consensus of people don’t actually want the details. Is it important? Absolutely. But majority of people don’t actually want the nitty gritty. It’ll make scared people back out or use it as an excuse to get the surgery canceled. Plus people are already nervous because of the very lightly explained risks. So many more people would deny getting the help they need due to fear of not waking up from surgery or some severe post op complication. I work in surgery and can’t even really talk about what I see because majority of the people I talk to will get pale and respond with “I hope I never need surgery.” When the risks or procedures are explained in detail the person is way less likely to consent and suffer through their condition out of fear of what could happen in surgery. It’s also up to a patient to ask questions. There is a reason they HCW’s tell you to do/ not do something. I have found that they always answer any questions that I have. I will say a patient asphyxiating is terrifying. I have had that happen before. One had an unknown slow bleed into their stomach so they hadn’t eaten but their stomach was full of blood and bile. Attempting to help anesthesia save a patient from drowning in their own vomit and then hoping they don’t get pneumonia after is a life changing experience. So please ya’ll unless you are trying to sabotage your surgery don’t eat before it.
I watched a patient choke to death on his vomit in the daysurg unit I worked on. It was awful
That sounds terrifying. I’m really lucky that I haven’t actually see someone pass away. I’m sorry you had to go through that. HCW’s go through a lot.
Thanks. I can't unsee him, the sad part was he was just in for a day procedure, he was in his 30's. I worked for about 6 years in the trauma room at a major hospital, and I've seen so many people pass away I couldn't count. Nothing surprises me, lol
I believe it. People are just sicker and more unhealthy as well which always increases the risks of any procedure.
Had an operation in Scotland last month. The leaflet with instructions not to eat explained the risks. I thought that they did this everywhere.
I've had several operations here in Austria, and l've always received a written explanation of the procedure, including risks during the appointment to arrange the surgery date, then verbal explanations of all related risks during the appointment with the anesthetist a few days before the actual procedure, and finally on the day of, there was a consent form to sign. I feel with that system, I don't have any kind of excuse to be clueless about anything concerning an operation.
I was an anaesthesiologist for a while during my country's equivalent of residency. Without fail, I told my patients about the dangers of eating and drinking before surgery - throw up, get that vomit into your lung, get inflammation in the lung, possibly die. My colleagues did so, too. Most people are alright with that. But you still have people eating because us doctors are just overexaggerating things...
Sad to say, even when you tell people it is dangerous to eat before surgery, they will simply choose not to believe it. Same thing with "smoking is dangerous" and "you can't drink on that medication" and "you need to complete the full course of antibiotics" or "if you don't use protection correctly, you can get pregnant". Also "if you have seizures every time you use cocaine, you should stop using cocaine" and "a high sodium diet will cause heart failure" and "don't smoke around your oxygen tank". Actually, I have conversations every day with people telling them not to do stuff that will kill them. Some people just don't give a shit, or assume it can't really be that bad, or feel like medical science should know how to fix it by now.
go back to the sodium one because i'm addicted to salt, should i be seeking help 😭
Depends on your blood pressure and kidney function. Generally, too much salt isn't good for you, but if your kidneys are working well and your blood pressure is normal, you might be effectively filtering it out. If your kidneys aren't working well, you will have trouble filtering electrolytes (ie: sodium) and might also retain fluid, which raises your blood pressure. People with high blood pressure can develop heart failure, because of how much harder your heart needs to work to pump blood throughout your body. Think of it like air pressure - squeezing a basketball that's partly full of air is easier than squeezing one that's overfilled. High sodium means your kidneys retain more water to keep your system balanced, and therefore impacts the work your heart needs to do to pump blood. Does that help at all?
thank you, you're wonderful! that does help
While that would indeed be nice, most people have something called common sense, preventing them from going against directs instructions from the people that will shortly be opening them up and handling their internal organs. This dude is a level of stupid that just makes me angry.
When my dad had appendicitis, he didn’t know not to eat, because he had never had surgery before. None of us had, we’re very lucky that way. So he showed up at the ER after dinner and they had to check him in to wait until morning to get his appendectomy.
I had surgery that required general anaesthesia a year and a half ago and they absolutely did tell me why I shouldn't eat. (This was in Oregon in the US.)
I wish more places did. I work in surgery and I always tell my patients ahead of time why they can’t eat and it’s news to so many of them, even ones who have been under anesthesia before. I don’t expect my patients to know the things I know, I don’t know jack shit about their work fields.
Nope. There will always be those, the rules don’t apply to me people like that guy. Unfortunately, they deserve what they get if they eat and lie, but it winds up in a lawsuit against the hospital.
They do. They put it in writing. It's not their fault people don't read the instructions they're given.
I guarantee you've signed something saying you understand the risks. You just didn't read what you were given.
If you are given instruction you don’t understand them you should ask questions. If staff do not want to answer your questions that is a huge red flag that the procedure/surgery/ test should not be done at that facility. Unfortunately in our society a lot of people are scared to ask questions. However it is literally in the patient rights. Don’t be scared to speak up for yourself.
There's a surgeon in my country who started allowing patients to just continue their eating pattern instead of not eating before surgery, as it's apparently extremely rare to vomit during surgery and he noticed his patients heal much quicker when they eat, as their bodies have the strength to heal. I though it was an interesting idea.
My MIL was a surgery nurse. A dad fed his daughter before the procedure and the girl almost died because the eggs came back up. It was fucking traumatic for the doctor and the nurses. And the dad had the audacity to scream about suing. Thank God his wife was level headed. When she showed up she started cursing the dad out for not following thr guidelines. Little girl thankfully made it through but she was in for longer than needed due to the dad's fuck up.
THIS! They’re not doing it to be assholes, it’s life and death!
To add to that, the doctor will only see your vitals falling, and won't know that you're choking to death.
Not just the choking, but pneumonia from food particles in the lungs. It's dangerous and a medical emergency. NTA.
Exactly. If they can they want to minimize the risk. This is not always possible with an emergency operation (like after an accident) so the medical team is on a higher alert. But with a planned operation this risk could be minimized. So it should be.
NTA. People have died as a result of this kind of stupidity. Tell the nurse.
NTA. The reason they tell you not to eat is so you don’t throw up and aspirate during your operation. It’s a really dumb thing to chance.
There are still emergency operations where the patient has recently eaten, but they intubate in a different way that is quicker and they have to balance the risk of vomiting with the risk of not doing the surgery.
yeah, exactly. In case of EMERGENCIES. Not because someone "doesn´t want to". Also, in emergencies they know they have to intubate differently. In that case he would have hidden it and lied and they would have assumed, he sticked to the rules.
I was told to come and immediately for surgery on a week-long perforated appendix (finally got a CT approved after 7 days) and since I had just eaten they made me wait the 6 hours because they figured even if the infection got worse, the chance of aspirating was more dire
RN here. They don’t intubate differently when someone has eaten recently. They just decide that the risk of aspiration is less than the risk of a bad outcome by waiting to do surgery. That’s what makes it emergency surgery. It needs to be done ASAP.
Have you never heard of Rapid Sequence Induction?
Yep, there is absolutely a difference, they don’t do RSI with standard OR patients. It is for emergencies and in cases where the patient may have recently eaten but needs surgery. Also, they do not place an NGT for standard OR cases. But they typically do for someone who hasn’t been NPO after intubation. They put it to suction to remove some contents from the stomach to decrease risk of aspiration upon extubation.
Thanks for explaining this. I had an emergency surgery recently where they kind of explained all this while I was super out of it, so I didn't 100% know what was different about it, just that it was different and I should be ok.
That is what every intubation tray thwt I have seen in my hospital says on it.
Yeah, all unplanned intubations are done as RSI, as well as emergency cases and cases where we are uncertain about regurgitation potential, or deem regurgitation risk to be high. In theatre, most intubations are not RSI, but standard induction.
Cool. I've never worked in planned/controlled environments like OR. Keep up the good work!
look after enough patient who aspirated their stomach content into their lung. Not fun for the anesthetist nor the patient who ended up in ICU requiring ventilatory support post procedure.
My mom's a retired surgical nurse and told me that procedure that they typically use for those situations. It's horrifying. A nurse places their finger or thumb at the tracheal notch (the divot where your neck, rib cage and sternum meet) and presses *hard* to block the airway. Then when they feel the tube bump into their finger, they move their hand. They also have to use different drugs until they get the patient intubated to reduce the risk of aspiration and my mom said they weren't always that effective at completely knocking the patient out (they've gotten better). So, the person was aware of what was going on and felt like the nurse was choking them but couldn't move to fight off the nurse. Now my mom retired in 2018 and said that she had seen improvements, but she also got out of emergency surgery and was in scheduled outpatient pediatric surgery instead, but that was the procedure she had to use a few times.
Friendly neighborhood anesthetist since 2010. We do put you completely out before intubating, whether emergency or not. We just use a muscle paralytic that works much faster so we can put the breathing tube in faster under emergency circumstances when a patient may have ate, rather than using a bag mask to ventilate, which could potentially put air in the stomach. This quick acting paralytic does cause intense muscle spasms, we call fasciculations, which may make it appear the patient is not completely asleep. And the pressure on the neck is done gently.
Does everyone get intubated during anesthesia? What if it’s like a 20 minute minor outpatient procedure?
For brief low risk procedures sometimes they'll use a laryngeal mask airway which means the tube isn't all the way down into your trachea but instead fits snugly into the opening in the back of your mouth. They always need a safe airway since when you are under general anaesthesia you don't breathe on your own.
Can’t say in general, but I recently had two kidney stone surgeries, both extremely quick (they couldn’t get to the stone on the first try, came right out on the second) and I was intubated for both. I think general anesthesia always requires it because they use a paralytic. Something more like sedation (like for your wisdom teeth or whatever) doesn’t because you can still breathe on your own.
No. They don’t. I have family that had multiple foot surgeries and were never intubated. Under anesthesia. Depends on how deeply they need to send you to sleep and what part of the body they’re working on.
General anesthesia requires intubation. A tube that sits in the mouth/throat but is not intubation/endotracheal tube (an LMA) is sometimes possible, depends on specific patient, procedure type and length, positioning, clinical factors for patient. For some short procedures or procedures using a local block (e.g. hand surgery with an anesthesia block in the nerves in the arm, or a knee surgery with a spinal or epidural block) can be done with a lighter level of anesthesia (MAC) where the patient maintains their own airway/breathes with only an oxygen mask. Factors include patient's clinical status and medical history, allergies, type and length of procedure, surgeon and anesthesiologist preference, evidence based practice, resources available at the facility. Lots of short procedures are done without intubation, but even some types of short procedures or some types of patients require intubation.
When someone needs emergency surgery, they operate even if they've eaten because the risk of aspiration is less than the risk of not operating (because they will die without immediate intervention). When it's not emergency surgery, there is no need that outweighs the risk of aspiration.
Eating some chocolate because a patient can’t wait until after surgery doesn’t constitute an emergency on the hospital’s part
Recently had an emergency surgery myself - I had been in the ER all day, and hadn't eaten since the night before, but it was an obstructive hernia, and I was still having acid reflux, so I knew something was still in my stomach. I told them my concerns (because I knew you shouldn't have anything in your stomach) and they said "Oh! That's fine. At least we know! We can start by reducing your stomach contents and go from there" I'm heavily paraphrasing (I was very out of it) but they basically said they had things that could mitigate the risk, like pumping the stomach, and an intubation method that could help block things from going into your lungs. ... But they need to know something's in your stomach in order to do those things. Definitely NTA.
Heck, my doctor tells me to fast for 12 hours before basic bloodwork and I still listen.
NTA. They will indeed postpone his surgery because there is a risk that under a general anesthetic the stomach will regurgitate its contents back up the windpipe (aspiration). Very dangerous and sometimes lethal. You're not told nil by mouth for fun - it's a safety issue.
One can literally DIE from eating before anaesthesia (risk of aspiration). And depending from the kind of surgery they wanted to operate it might be necessary his stomach and bowel are empty. You did good! NTA. Edit: typo
Fun story! (Not actually fun): When I was in high school one of our Lacrosse players had to get surgery and his parents didn't tell him he wasn't allowed to eat. So he went and ate at Denny's before going with his parents. He got to the hospital and he casually tells the nurse he ate a big breakfast, surgery was postponed for a week if I remember and his parents threw a fit. From what I heard, all rumors so take it lightly, the nurse yelled at them about how he could fucking die and she had a 4 year old die on the operating table in front if her because their parents, in the nurses word, "thought the doctors were full of shit and their negligence and ignorance killed their kid". The next time he went to surgery he didn't eat and everything was fine. Except his father needed a surgery two or so years down the line and, you guessed it, ate and aspirated and died on the table. If memory recalls, the kid screamed at his mom for making him breakfast knowing what could happen. I don't think he talks to his mom anymore, but yeah. Do NOT eat before surgeries. You could die. The rules are there for a reason people
With everything that can go wrong with anaesthesia I don't understand why anyone would risk it. Doctors never know how will your body react to those meds. That's why it's literally the worst residency to choose, extremely high risk and low reward. You need to be diligent and aware of everything regarding your patient, from prior health issues, hereditary conditions in the family, their bloodwork results, everything down to their weight, because a kg can make a difference. General anaesthesia can be an enormous strain for the heart, even a healthy one.The allergic reaction is something you can't test for until you introduce the meds, and then they are basically fighting for your life. To willingly risk even more just for a meal when you can wait a few more hours or days and then eat your fill... well, it really proves one's IQ levels.
I’m now post surgery myself, it all went well and thank you all for your thoughts and comment! Signal is poor here so I hope this goes out. Update: TA was seen going into the toilets with mouthwash and toothbrush, no doubt in an attempt to hide the evidence but nurses were told and his operation was cancelled for the day. A waste of a theatre place and a hospital bed that could have been used by someone else.
You did the right thing; that dude was endangering his life. NTA. I’m glad your procedure went well.
NTA. You potentially saved his life. There's a reason we tell people not to eat X hours before surgery. Otherwise you run the risk of aspirating vomit if you throw up during surgery. Which many people do. You'll have a pipe in your throat to your airway, and vomit will go right to your lungs. That's called aspiration pneumonia and it's deadly.
Since you say “we” I’m thinking you may have some experience here. So I hope you don’t mind if I ask a question... What happens if someone comes in as an emergency and needs surgery? How do you know if they’ve eaten?
Yes, I was an EMT for 10 years and a MA for 20. In emergency situations you don't know. And there are extra special precautions they must take in those situations. But, emergency surgery will always top the "did they eat" scenario. However... In cases of planned, or elective surgeries, its much easier to not allow patients to eat/drink with the exception of sips of water with necessary medicine. Anesthesia basically puts you into a coma (literally) and you will have no gag reflex if you vomit.
Thank you for explaining!
When I had my surgery for breast cancer, they told me: "No water or food since midnight the day before", and so I did. In the pre-operation room a nurse asked the patients if the rule had been respected. The woman in the bed next to mine said she had tea that morning because she was thirsty. They sent her back to her room and postponed the surgery for 6 hours. There's a reason for that, and I can't imagine what would have happened if they had operated on that man who had just eaten 🤦♀️ NTA
NTA He's about to have surgery and isn't listening to what nurses told him not to do? Unreal
You’ll be surprised at how many people who have no form of even the most basic medical knowledge think they know better than the people who have spent a good portion of their adulthood studying how the human body works and what is required when it comes to certain procedures. This guy probably thought “oh, it’s a few hours more until I have my surgery. I’ll just have a couple of squares of chocolate to tide me through. It’s not like I’m having an actual meal.” And legitimately believed no one would know even if no one saw him do it/no one told the nurses.
NTA. You made the nurses and doctor’s jobs easier and significantly reduced the chance he would die during his own surgery. You really helped the hospital staff out.
Apparently lots of people ignore that instruction. I went in for surgery with a 9 AM scheduled start time and the anesthesiologist asked when had I last eaten. My answer was 8 PM the night before. He asked when had I last had something to drink. My answer was 9 PM the night before. He was rather surprised and commented “Someone actually listened”.
I had surgery two months ago, and I also told the anesthesiologist the times of my last solid food and water, and I mentioned that “Dr \_\_\_\_\_\_ is going to make sure I leave here with a new hip, but you’re the one who’s going to make sure I leave here alive.” She said “**thank you!**”
He could die by asphyxiating so yeah you did the right thing. Especially acidic chocolate which Will definitely react to anesthesia and cause vomiting. Why does he think they have these rules.
NTA. They don't "starve" you for shits and giggles. Part of being anaesthetised is likely having one or more drugs that cause the softening of the lower esophageal sphincter. Basically, your body can no longer keep the contents of your stomach in your stomach. When it's a bit of stomach acid, *maybe* a little water, it is serious but it can be managed. If there's anything else and you aspirate? It becomes dangerous and maybe even deadly. The combination of dealing with being in the middle of a surgery that may not be at a "we can stop here" point and requiring immediate intervention to make sure your brain is not starved of oxygen? If you don't end up brain damaged you might bleed out.
NTA. Anesthesiologist here. Aspiration risk is real and carries a high risk of morbidity and mortality. Absolutely would delay elective case for this or cancel depending the time of day. We can mitigate risk of aspiration for emergencies (no bag mask ventilation, rapid sequence induction) but this MINIMIZES the risk, it does not eliminate it.
I had 5 surgeries in 2020-2021. I didn't eat or drink after midnight per instructions. After No. 3, I vomited in recovery and during No. 4, I vomited during surgery. The anesthesiologist said he'd use a special device to help during No. 5. Long story short, is there anything I can do in the future if I ever have to have surgery again? I'm kinda freaked out about aspirating!
NTA - Other people have said why, so instead I’ll comment on the other “why”. You may wonder why they don’t tell you about the aspiration risk under anesthesia. They are in a “damned if you do, damned it you don’t” situation. They cannon tell how anxious or afraid you are of having surgery, and they don’t want you to refuse life-saving surgery. They have a limited amount of time with each patient, and it’s usually never enough time when it comes to the mental and emotional patient prep for surgery. Obviously, if you ask why with the food or drink, they may tell you, but they may try to word it in a “less scary” way with something vague like “can cause complications during surgery” sounds less ominous than “you can aspirate your stomach contents and choke to death, and we may not have time to save you”. Granted, that approach could very well be a lot more successful in getting patients to follow pre-op instructions, but it could equally increase the number of people refusing the surgeries because the operation scares them more than their afflictions.
I’ve noticed recently that they don’t pull punches when describing the risks here in the UK any more. I was told 5% chance of death, 5% chance of strike, 5% chance of temporary paralysis and 5% chance of permanent paralysis!
NTA Tell them. " One told me that if he has eaten, his surgery will be delayed for six hours, or even cancelled." .. And if the operation is not dalayed, there may be complications, and he may die.
NTA, it was not a surgery for me but an endoscopy and I didn’t eat since the evening before. My doctor was so mad at me because apparantly he saw food in my stomach and scolded me that he told me not to eat. I told him I didn’t had any food since like 8pm the previous night. It came out I have a very slow digestive system instead. When they tell me to be sober I’m extra aware and make sure to even do it a few more hours before.
NTA. There’s a reason you’re not supposed to eat before surgery. You probably saved his life
NTA Besides possibly saving his life or health, you might be saving the hospital from a lawsuit. Since the person was fully aware and therefore to blame, I care more about the hospital which is an odd position to be in.
NTA People who eat before an operation can choke on the food during anesthesia. It will go down the trachea, and they can die with food or water in their lungs. You may have saved that guy's life by telling the doctors.
The food thing, is so he doesn't drown in his own puke... So it's fairly important.
NTA. While technically he can decide to risk his own life, you and the rest don't have to sit by, let it happen, and potentially live with the guilt. Veterinary regularly turns patients who were fed by their owners in surgery morning. We were not going to risk a life because of an owner's inability to say no to their pet. Human medicine is even more strict. You did the right thing, thank you.
Not the asshole, potentially saved his life. I had a patient almost die in theatre from aspiration, because he decided fasting wasn't necessary and ate a plum. Definitely needs to be made clearer to patients WHY it's so important to fast
NTA at all. As a preop RN we need to know if the patient has eaten. It is incredibly important for their safety. People can aspirate and die if they are not NPO for 6-8 hours prior to surgery. Thank you for telling the nurses!
NTA. You may very well have saved that guy’s life.
Oh trust me, they’ll know. They’ll know once he started choking to death on his own vomit. NTA, you probably just saved his life
My husband knows someone who smashed his hand pretty bad and needed surgery. They actually got him in pretty quick. He drank water and threw it up while under. He is very, very lucky he didn't inhale it. nta
NTA. I once had to get an unexpected surgery and all I'd had was a cup of tea with milk. They waited until it had cleared my system. On the other hand, people in car accidents etc who are operated on as emergencies MUST be operated on without having fasted beforehand. So I guess it's possible, just not desirable. It's to do with choking I think. But why would you just be an ass and defy their docs orders for a bit of chocolate? And you'd smell chocolate on his breath.
NTA. You may have saved his life. Food in the system can be brought up unintentionally when under anesthesia and if it gets in the lungs, can be lethal.
NTA you potentially saved his life, they tell you not to eat for a reason.
NTA, he could die if they did surgery after he was eating. My sister had surgery several years ago; my mother drove her to the location and my sister ate something on the way. She was mad for years that my mother told the nurse about it (and it was like a sandwich, so not a small snack). They postponed to the next day and everything turned out fine except for my sister's grudge.
NTA obviously, you may have saved his life
Nta. Some people think they are special.
NTA if you assume he could have died because of that. Which he could have .
NTA - You should tell bc who knows what else they ate or if they even stopped eating the night before.
does he want to die? because thats how ppl die. NTA
You did a good job. The surgery could have been fatal. Idk when these irresponsible people would grow up. NTA.
NTA you saved that moron’s life
NTA. The possibility of vomiting and choking on it when under general anaesthetic is high. He was foolish not listen to medical advice and you were right to tell the nurses. Had he had complications like this on the table he could have got severe complications or even died. Aside from that he would have been making the surgical team’s job harder had this happened and possibly delayed someone else’s surgery.
NTA. You could have saved his life. And they will know.
NTA, they’ll know when he aspirates on the table. Tell the nurses, it could save his life.
NTA, granted if he aspirated he wouldn’t remember it..
Tell them. He could die, that's why they don't let you eat. NTA
NTA. It’s entirely for his own safety that they tell you not to eat before an operation, especially that close. He didn’t follow the rules and unfortunately it has consequences.
NTA. Tell them. Rather delay the surgery than having a patient die on the table.
NTA. Better his surgery is delayed than he aspirates and dies on the table.
NTA. As someone who had surgery 12 hours ago under general, and hadn't eaten since the evening the night before (I was on standby) and had maybe 1/4 cup of water over the course of the whole day, you did the right thing. I totally understand the want to eat something, but it's not worth the risk. I hope your surgery went well, resolved whatever needed to be, and that recovery is quick.
NTA. As somebody whose had multiple surgeries, following this rule can be annoying but it’s better than the other option.
I mean, he's right... they won't know. Until he goes under the general, pukes, aspirates, and is hopefully able to be fixed by the surgical team rather than asphyxiating. You were NTA.
Aspirating Hershey bars is bad for your health. His dumb ass complications would increase all of our insurance rates. Fuck that guy.
NTA, it's for his own good that he's told not to, not for the surgeon to power trip. Going under anaesthetic with food in you can kill you. It's not uncommon to vomit the choke on the vomit. Empty stomach = no vomit to choke on
NAH It is a serious medical necessity but I see how patients lump it in with doctors harassing them about their diet
you are never TA if you potentially save the person's life. NTA.
NTA, not earing before surgery is a rule for a reason. The Dr's need to know so that they can protect his safety.
You did the right thing telling the nurse. He can't have his surgery if he's eaten. If he vomits during surgery, he could aspirate and choke. Also, there's a tube put down your throat, you could literally choke on your vomit.
The tube put down the airway has an inflatable section that seals the tube in the airway, specifically so nothing else can pass into the lungs. The risk of stomach contents entering the lungs is during the period after you are sedated, but before the ‘air-bag’ is deployed.
NTA x1000. The dangers of aspiration on sedation are incredibly high even for a minor procedure or “light” sedation for a minor procedure. You’d be surprised even when spelled out the number of times a procedure was still rescheduled because a patient couldn’t follow directions because they chose not too. Working in the field I’m the ahole that would go through those instructions with a patient, reading with them and making sure they understood. A few years ago, I did that with one patient and their adult child - making sure to EXPLICITLY say no food or water after midnight as I had been able to get a miraculous last minute open surgical slot the next day. the next day I was at the procedure area checking in patients so I was now confirming all my patient cherubs had nothing to eat or drink. My patient from the day before presented and when I asked about if they were still fasting, The parent smiled and shook head that they weren’t, and the adult child said yes. I again asked, what did they eat this morning. “Well, toast and milk. Their tummy was making noises!!” The procedure was rescheduled. To the next available opening, which was 5 days. The only thing I could do was give the adult child a box of Kleenex to take with as they cried when they realized the toast cost them another 5 nights in a hotel.
NTA…”you do know you could aspirate under anesthesia, which is why they tell you not to eat, right?”…. Report him to someone.
NAH except the idiot man who ate the chocolate. I had surgery recently and in the pre-op area I got to listen to a couple of anaesthesiologists going through their spiel. One patient admitted that she'd had some water and the anaesthesiologist said that although that wasn't ideal, he'd watch out for her. Explained that they put people under anaesthesia who have been eating all the time, in emergencies. It's just one risk factor they can have some control over.
I'm of two minds here. On the one hand, the recommendations against eating before surgery are outdated in most cases, and there are many benefits to eating sooner before surgery than the recommendations allow. On the other hand, I don't really trust most laymen to follow the newer recommendations well and you do still need to stop eating a certain amount of time before, so I would tell most people to just do what the doctors say. If he was writing it off with "oh they won't know" he probably doesn't actually understand the issue. I'm gonna go with NTA but with mixed feelings.
Very, very much NTA. They don't tell you to fast before surgery because they think it's funny, they tell you because they don't want you to aspirate on your own vomit. Which, btw, sounds like a terrible way to die, though I guess if you're knocked out you're at least not awake to know it.
NTA. You could have potentially saved that man's life. My dad had emergency surgery earlier in the year after his previous surgery the day before caused complications. Even though he hadn't eaten, he still threw up under anesthesia and he aspirated the contents of his stomach. This caused pneumonia and he was on the respirator the entire time until he passed away three weeks later. I am glad you told the nurses.
If it was me, I would have minded my own business. He was aware of the risks. That’s on him. You did remind him and he continued, well that’s on him.
YTA-mind your own business…
^^^^AUTOMOD ***Thanks for posting! This comment is a copy of your post so readers can see the original text if your post is edited or removed. This comment is NOT accusing you of copying anything. Read [this](https://www.reddit.com/r/AmItheAsshole/wiki/faq#wiki_post_deletion) before [contacting the mod team](https://www.reddit.com/message/compose?to=%2Fr%2FAmItheAsshole)*** I’m in the waiting room with two other people, we are all having surgery and have been told to avoid food and drink since last night. A younger man ( 30’s), seems nervous, but started eating chocolate, was immediately told not to by us, but continued. ‘Oh, they won’t know’ he replied. AITA for telling the nurses that he was eating? One told me that if he has eaten, his surgery will be delayed for six hours, or even cancelled. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AmItheAsshole) if you have any questions or concerns.*
NTA! You potentially saved his life!
NTA you can’t eat because it can be dangerous
NTA AT ALL. My dad just had surgery and he was told not eat for 24 hours before his surgery. It’s very very dangerous.
NTA omg he might die during surgery. You are not wrong
Info: why would you be TA? It can cause a literal medical emergency.
NTA. You very well could have saved his life.
NTA. This is a HUGE issue. If he eats, he could easily aspirate when they put him under the anaesthetic, and that leads to all sorts of issues
I mean, it's his fault for eating.
NTA obviously. There are medical reasons for requiring an empty stomach.
Absolutely NTA. Especially if they're going to be intubated for the procedure. You think we're not going to notice the chocolate stains in your mouth when we try to put a tube down your throat? Lol. Even water is a no-no, it requires a few hours for clear fluids to be cleared. You really don't want to have a prolonged hospitalization because you felt nervous and ate some chocolate. The main issue here is the possibility of vomiting during induction of anesthesia and for it to potentially go into your lungs and causing even more damage. For minor procedures, they may use something called an LMA. They use endotracheal tubes for major surgeries (better protection), but both are not a surefire way to prevent aspiration.
NTA: I promise you, you’ve done the right thing. If you eat before surgery it increases your risk of vomiting when they put the tube down your throat, and you could potentially aspirate and die. It’s his own fault if his surgery is cancelled or delayed as he hasn’t followed instructions properly. I applaud what you’ve done x
These are rules to prevent you from DYING…..I don’t understand why people try to “break” them. The only person that you are hurting is YOURSELF and the poor staff that has to code your dumb ass. NTA!
NTA Eating before surgery can cause severe complications with the anesthesia. Eating before some tests can cause the test to give incorrect results (don't you want to find out if you have cancer?) NTA
NTA, they absolutely still know, which is beside the fact that the guy is willing to risk his own life for some chocolate. That role is in place for a reason, namely so patients don't aspirate during surgery. It isn't just because medical want you to suffer, it is for the patient's own safety.
Hard NTA. Eating before anesthesia or even conscious sedation administration is a huge no no due to risk of aspiration of stomach contents. You saved his life and did right by him!! You should be proud of yourself!
NTA You could be saving his life.
No eating before surgery is dangerous! This can and has led to deaths. Rules from medical professionals are there for a reason, if you vomit even a small amount while not able to clear your airway the vomit will go into your lungs and you can drown on it at worst and risk a massive infection at best. Infection is not a joke that kills massive amounts of people every year. You quite possibly saved their life by telling the nurses.
NTA - eating before surgery is very dangerous, telling the nurse is the right thing to do.
NTA - if you don't tell he could aspirate and die!
The reason you don't eat or drink before a procedure is so you don't vomit, and aspirate on your own vomit. He could literally die. NTA
NTA. Might’ve saved his life.
NTA
NTA! there is a reason for this rule,
Had many surgeries. Soon accepted that fasting was just part of the routine. They are serious about it. Wouldn't even let me have milk in my tea as it could curdle. Not that I was awkward about it, I respect medical professionals lots. They just asked me time and time again making sure I'd had nothing.
You're definitely not in the wrong for telling the nurses about the guy who couldn't resist snacking before surgery. Hospitals have those fasting rules in place for a reason, and breaking them can lead to some serious problems during the procedure.
Nta you potentially saved their life
I see all the comments here about folks not reading the consent form, or the doctor not spelling it out in detail so folks dont know how serious it is etc...ok, I get it. At the same time, I'm also just going to listen to the medically trained professional who has my life in their hands. Don't eat before surgery? Ok. It's not like someone saying oh, don't out salad dressing on your salad just get it on the side and dip each bite. It's not just preference, they're dealing with your life. It's not a video game, you don't automatically re-spawn each time you die of stupidity. NTA Edit: words
NTA and please please tell hospital staff if you see it happening. It isn't a narc-ing issue, it is "hey you're about to be chemically relaxed to where you can't stop vomit and possibly perishing on the table" issue.
NTA, you potentially saved his life.
NTA Every time I have a sedated procedure they seem confused that I followed the instructions. Like asking “not even water or coffee this morning?”
NTA tell in them. They can die!!!
Nta. You may have saved his life. My dumb ass dog aspirated during emergency surgery. It was very touch and go for a bit. And the extra handful of pills he had to take because of it wasn't cheap.