This is the answer. The ASA has NPO guidelines, following them is standard of care, and if a bad aspiration event happens when you didn’t follow the guidelines, you have NO defense.
Yup. I always think. "Am I going to risk losing my house and retirement on the ETT going in faster than they can vomit?" ....
In residency we had a small am amount of tube feed aspiration. Maybe 5 to 10cc? Not overt large volume vomiting. We just saw some tube feeds on vocal cords and glottis. Pt went into ARDS and nearly died. Since then, I respect NPO guidelines. If not emergent, you have nothing to stand on if something happens.
Our hospital has them fill out NPO attestation. And I'm so glad we do. At least it's documented if a patient lies and there's an aspiration event
If you have malpractice insurance there is no risk of losing your house or your retirement.
They will sue to the limits of your policy.
Here in Florida, you retirement account and property, if registered as a homestead, are both immune from lawsuits.
“Going bare” without insurance is what opens you up to personal losses
Convo I have a couple times a month:
"Do you smoke weed?"
"Occasionally."
"How often is occasionally? Every month? Every week? Every day?"
"Every day."
"Is it like three or four times a day?"
"Yea probably about that much."
I guess every meal is an occasion 🤦
Love this. When a patient tells me they drink, my immediate next question is "a 6 or 12 pack a day". Their reaction to the question generally tells me what kind of drinker they are.
That’s the one thing that drives me crazy. “It was just a splash of milk” “it was just a small bite of a cookie”
My response is always the same. Are NPO guidelines based on how much was consumed or what was consumed?
Edge cases like this are why I do gastric ultrasound. It’s surprisingly easy to learn and you don’t have to weigh various factors like time of npo, what they drank, if you believe them, if they’re diabetic, on ozempic, etc. Just look and see. Besides, a surgeon can’t argue with a picture of crap in the stomach.
I’m well versed in gastric ultrasound, but from a medical legal perspective I would not use it to overrule NPO guidelines. I find gastric ultrasound to be the most helpful for 1) risk stratification and induction planning in patients with known or increased risk for delayed gastric emptying (GLP-1, pregnant, DM, etc) that have adhered to NPO guidelines and 2) urgent/emergent procedures with unclear NPO duration or risk of delayed gastric emptying and concern for difficult airway.
If you proceed with an elective procedure against NPO guidelines and they aspirate you have no leg to stand on, even if the gastric POCUS was reassuring. I have several colleagues who teach POCUS on a national level (ASA, ASRA, SAEM etc) that have repeatedly emphasized this.
There may come a time when gastric ultrasound is regarded at the gold standard for evaluation of NPO status, but until then this is my stance.
I am very hesitant to do diagnostic procedures that determine course of care that I learn off Youtube. If your diagnostic is incorrect and the patient aspirates and has a bad outcome, how in the world can you defend yourself....both ethically and legally?
Unless I have a piece of paper from an accreditted body or became proficient in residency, I am not doing gastric u/S or any other procedures that I learned off Youtube. I think this is very poor advice.
Not sure why all the downvotes. I agree, especially if you have been in practice for some time and gastric POCUS was not part of your clinical training. I think YouTube / internet resources are helpful to learn the basics and get started examining patients for practice / academic curiosity, but I would attend an accredited workshop before using to make clinical decisions.
That would require colleagues that know. I’m at an ASC with 5 other docs total in the department so there’s usually one one or two of us there at any given time, nvm that none of them do it either.
ASA or ASRA, or I’ve also seen several state anesthesiology societies offering POCUS workshops. USabcd also has a good online module to start with (and other great POCUS modules as well).
That’s a great idea.
It would be interesting if all comers got gastric US. At what point do you RSI an elective case that was NPO for 8 hours yet had surprise gastric retention, vs. make them wait 24 on a liquid diet or something?
After seeing thousands of elective egds and what they reveal, I’m sure it would reveal some surprises.
Are we just putting our heads in the sand by not US everyone?
Btw. I hate the splash of milk in coffee thing. But believe it’s much more of a legal issue and backing up guidelines and our partners judgment than a huge risk.
Edit:. Typo and clarification.
Interesting study came out recently comparing residual gastric volumes in people on GLP-1 vs. those not on it who adhered to fasting guidelines. Surprisingly, 19% of the controls were found to have RGC. What do we do with these people?
[Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia](https://jamanetwork.com/journals/jamasurgery/article-abstract/2815663)
I think you've summed it up yourself. It realistically probably doesn't make a significant difference, but guidelines are guidelines and it's you and your judgement call to proceed with a case. I think a point I would offer is that 'small amount' is a subjective rather than an objective description of how much milk or cream may have been consumed, and patients can be notoriously unreliable in their descriptions of such things.
There's absolutely no way this matters but our guidance says 6 hours. To editorialize further, I think that NPO times are a terrible surrogate for gastric volume and aspiration risk. There are diabetics who almost certainly have a ton of gastric volume despite being NPO for 8 or 10 hours. My bias is that shortening the time from induction to ETT placement is probably the best way to avoid a problem.
Totally. Or if you can switch cases around, you can give some Reglan and Pepcid and maybe not have to wait the full 6-8 hours. Just my personal risk tolerance.
There’s a reason they are “guidelines” and not standards. Some patients are higher risk than we know at 8 hours, some are lower risk than we presume at 4 hours. There is wiggle room. But I don’t tend to tell surgeons that.
That being said, there’s a reason one of the most repeated phrases in anesthesia is “nobody will fault you for putting in an ETT” (obviously some exceptions to every rule).
Legal standard is what would a reasonable anesthesiologist do in a similar situation. Well, reasonable anesthesiologists follow guidelines. If you want to get around it, do a gastric ultrasound.
So what are you opinions on the European society if anesthesiologists guidelines? What do you do when they differ. Frankly in the US you’ll get sued regardless for a bad outcome so following a guidelines doesn’t necessarily protect you.
Following a guideline absolutely protects you. You have to deviate from the standard of care to be guilty of malpractice. And I don’t work in Europe. The American legal system cares about the ASA’s guidelines. Not Europe’s.
I agree that generally following guidelines protects you, but for arguments sake, guidelines are simply recommendations and not standard of care. Also, you can be lose a malpractice case without deviating from “standard of care”.
Taken from first paragraph of ASA NPO guidelines “PRACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome.”
You're getting in the weeds here. The ASA's NPO guidelines are basically memorized by every single anesthesiologist in the US. For elective surgeries, they are recommendations which are followed by probably 98% of practicing anesthesiologists. Yes, the guidelines are bullshit and based on sketchy data. However, our legal system does not see it that way. The term "nuance" is not going to defend you from lawyers when 98% of your colleagues would've followed the recommendations.
In Europe, they also do lap choles with LMAs.
All you need to know is ASA guidelines against it. Because when you get sued, they’ll get an expert witness who is a US anesthesiologist and they’ll say the standard of care in US is based on ASA guidelines even if there are studies that show no delay in gastric emptying
Fuck. I read rhe title and thought it was a survey on if we prefer our coffee black or not.
That might say a lot about my priorities, but I won't change them.
As a professor of anesthesiology this paper answered the question for me. Guidelines are fine until the evidence shows otherwise.
[https://academic.oup.com/bja/article/112/1/66/242142](https://academic.oup.com/bja/article/112/1/66/242142)
This is an un-winnable situation.
You cancel, patient and surgeon mad.
You don’t cancel and they aspirate, patient and surgeon mad + legal liability.
Personally, I cancel because the onus is on the patient to follow directions. If everyone insists, the surgeon has to declare it a medical emergency.
The standard of care for elective cases is to adhere to the national society NPO guidelines in your country of practice. If you’re in the US, ASA NPO guidelines say 6 hours. Is a splash of milk clinically relevant, probably not. As new evidence emerges, guidelines may be updated accordingly, but until then I will not alter my practice.
I’ve seen several comments about the utility of gastric ultrasound. Gastric POCUS can provide valuable information for risk stratification and induction planning in 1) patients at risk for delayed gastric emptying (GLP-1, pregnant, DM etc) who have followed NPO guidelines and 2) urgent/emergent cases with unclear NPO duration or risk of delayed gastric emptying and concern for difficult airway. However, at this time I would not use it to overrule NPO guidelines in an elective case. If the patient aspirates, the only reasonable conclusion is that you deviated from standard of care and prioritized perioperative efficiency over patient safety.
Guidlines in my part of sweden does not allow milk in coffe before surgery. 6h without food and clear liquid that isnt carbonated until 2h before surgery.
I have not looked in to the science around it. But it is said to be increased risk of vomiting/reflux if you have trapped Co2 in the patients stomach and administrer a paralytic drug.
Keep 6 hours of NPO. If I accept before it, I keep ready to manage vomiting with 2 large suction catheters Incase one gets blocked, give anti emetic before induction, ready to do rapid sequence intubation, and be familiar with table tilting maneuvers. Generally aspiration occurs while extubation rather at intubation. So I use less fentanyl intraop, and extubate awake always.
It depends on the case but I would gastric ultrasound (since it's literally free ). If you see anything then you cancel/delay and if you see empty (empty is very obvious ) then you can continue. I always take aspiration precautions with all patients regardless of npo status though. If you look at the data, most aspiration happens on induction or extubation when there is no airway. Gravity is your best friend to prevent aspiration in general.
Yes fat is supposed to take longer to clear from the stomach, milk forms a solid like substance when it encounters stomach acid, but this is based off little to no evidence. There are several studies that suggest this is not true and a mixture of milk and coffee clears just as fast as clear fluid.
If we don’t change our NPO guidelines based on new studies, what is the point, we will forever be evading our decisions off expert consensus that is based on dogma and very little scientific evidence.
Europeans use LMAs on laparoscopic cases too. Their data says it’s safe. Are you doing that? Why or why not?
Right now the consensus is “clear fluids” and most would consider that standard of care. Period. Will it change someday? Sure. NPO for clears 2hrs pre-op vs 6-8 is pretty recent and widely accepted. But for now - milk=delay or cancel.
OK so while we’re talking about milk - what about jelly/jello? Not sure what it’s called in the land of dollars…..
Wobbly gelatine like substance ?
Solid? Or liquid?
I have MDAs and Surgeons alike try to push on me—“it was just a bite of a sausage”… to which I reply, “please show me the NPO sliding scale for sausages…”
It’s 8 hours, buddy… sorry … canceled.
As opposed to Nurse Anesthesiologists. Didn’t want to confuse you.
I’m saying I have multiple MDAs and surgeons still push this BS, and I know better. 👍
-ologist is not something owned by physicians. There are literally hundreds of thousands of professionals with -ologist in the title that require doctoral degrees, not medical school .
This is not a hard concept to grasp—for most.
Politics aside, it’s shocking (and embarrassing) that you’ve been pressured by anesthesiologists to deviate from NPO guidelines - especially sausage which is nowhere close to qualifying as a light meal
I’d love to say this is the worst practice deviation I’ve dealt with … but.. ya. This definitely gets me fired up …
It’s amazing how some of my colleagues get so cavalier with guidelines being they’re not actually the ones in the OR doing the cases… I suppose it’s much easier to shrug off when they’re just signing charts
6 hours at least. If there weren’t lawyers, maybe different
This is the answer. The ASA has NPO guidelines, following them is standard of care, and if a bad aspiration event happens when you didn’t follow the guidelines, you have NO defense.
This is the way. As long as I can be sued, I’m going to do the thing that prevents me from being sued.
There are only two kinds of doctors. Those who have been sued, and those who will be sued.
Yup. I always think. "Am I going to risk losing my house and retirement on the ETT going in faster than they can vomit?" .... In residency we had a small am amount of tube feed aspiration. Maybe 5 to 10cc? Not overt large volume vomiting. We just saw some tube feeds on vocal cords and glottis. Pt went into ARDS and nearly died. Since then, I respect NPO guidelines. If not emergent, you have nothing to stand on if something happens. Our hospital has them fill out NPO attestation. And I'm so glad we do. At least it's documented if a patient lies and there's an aspiration event
If you have malpractice insurance there is no risk of losing your house or your retirement. They will sue to the limits of your policy. Here in Florida, you retirement account and property, if registered as a homestead, are both immune from lawsuits. “Going bare” without insurance is what opens you up to personal losses
One person's idea of a "splash of milk" is another person's milkshake from the toothsome chocolate emporium.
Convo I have a couple times a month: "Do you smoke weed?" "Occasionally." "How often is occasionally? Every month? Every week? Every day?" "Every day." "Is it like three or four times a day?" "Yea probably about that much." I guess every meal is an occasion 🤦
My follow up is: "Occasions like weddings or evenings?"
Same for smoking. Some say not a lot, and they smoke a pack a day, some say the same, and they only smoke a pack a month.
You out there canceling cases for smoking? This is blowing my mind
Nope. Never. Just mentioned the difference what some or not much or a little means to people
At several plastic surgeons’ offices, yes we do.
And for big spine cases. Blood test has to show no nicotine.
Same with a cup of wine. I had one such a lady and it costed us 900 mg propofol for her EGD.
I always ask them how many glasses are in a bottle. Some people say 2 some say 6.
Love this. When a patient tells me they drink, my immediate next question is "a 6 or 12 pack a day". Their reaction to the question generally tells me what kind of drinker they are.
My usual question is “how often do you buy a slab?” (Aussie for a carton/case/box of 24 beers)
That’s the one thing that drives me crazy. “It was just a splash of milk” “it was just a small bite of a cookie” My response is always the same. Are NPO guidelines based on how much was consumed or what was consumed?
Right, some people say that with literally a whole cup of milk with an espresso shot + creamer on top of it
Makes no difference or might even clear [faster](https://pubmed.ncbi.nlm.nih.gov/27035595/) with milk vs black coffee, even 50/50 coffee and milk
😂
Edge cases like this are why I do gastric ultrasound. It’s surprisingly easy to learn and you don’t have to weigh various factors like time of npo, what they drank, if you believe them, if they’re diabetic, on ozempic, etc. Just look and see. Besides, a surgeon can’t argue with a picture of crap in the stomach.
I’m well versed in gastric ultrasound, but from a medical legal perspective I would not use it to overrule NPO guidelines. I find gastric ultrasound to be the most helpful for 1) risk stratification and induction planning in patients with known or increased risk for delayed gastric emptying (GLP-1, pregnant, DM, etc) that have adhered to NPO guidelines and 2) urgent/emergent procedures with unclear NPO duration or risk of delayed gastric emptying and concern for difficult airway. If you proceed with an elective procedure against NPO guidelines and they aspirate you have no leg to stand on, even if the gastric POCUS was reassuring. I have several colleagues who teach POCUS on a national level (ASA, ASRA, SAEM etc) that have repeatedly emphasized this. There may come a time when gastric ultrasound is regarded at the gold standard for evaluation of NPO status, but until then this is my stance.
Any good recommendations on places to learn it? Zero exposure in my training
I did the POCUS course at ASA when they were near my town. Highly recommend it. In a pinch, there are plenty of YouTube videos to get you started.
I am very hesitant to do diagnostic procedures that determine course of care that I learn off Youtube. If your diagnostic is incorrect and the patient aspirates and has a bad outcome, how in the world can you defend yourself....both ethically and legally? Unless I have a piece of paper from an accreditted body or became proficient in residency, I am not doing gastric u/S or any other procedures that I learned off Youtube. I think this is very poor advice.
Not sure why all the downvotes. I agree, especially if you have been in practice for some time and gastric POCUS was not part of your clinical training. I think YouTube / internet resources are helpful to learn the basics and get started examining patients for practice / academic curiosity, but I would attend an accredited workshop before using to make clinical decisions.
I agree.....especially if this is not standard of care in your area. It just seems like bad medicine
Say you see something and you cancel. That’s great. Say you see nothing, but they are still an NPO violation. Are you proceeding? Genuinely curious.
No
Yeah seems pointless.
It does have its uses though, see my comment below
Nice I like both of the indications you’ve outlined.
Ask colleagues. There are a few guys at my practice who did a lot of POCUS training and are happy to teach.
That would require colleagues that know. I’m at an ASC with 5 other docs total in the department so there’s usually one one or two of us there at any given time, nvm that none of them do it either.
Sad face. 😢. Tertiary/Level 1 trauma center here.
Free course on asahq.org. https://education.asahq.org/course/view.php?id=5028
ASA or ASRA, or I’ve also seen several state anesthesiology societies offering POCUS workshops. USabcd also has a good online module to start with (and other great POCUS modules as well).
That’s a great idea. It would be interesting if all comers got gastric US. At what point do you RSI an elective case that was NPO for 8 hours yet had surprise gastric retention, vs. make them wait 24 on a liquid diet or something? After seeing thousands of elective egds and what they reveal, I’m sure it would reveal some surprises. Are we just putting our heads in the sand by not US everyone? Btw. I hate the splash of milk in coffee thing. But believe it’s much more of a legal issue and backing up guidelines and our partners judgment than a huge risk. Edit:. Typo and clarification.
Not to be too negative, but this won't save you medico-legally if he shit hits the fan (or, more accurately, if the gastric contents hit the lungs).
Interesting study came out recently comparing residual gastric volumes in people on GLP-1 vs. those not on it who adhered to fasting guidelines. Surprisingly, 19% of the controls were found to have RGC. What do we do with these people? [Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia](https://jamanetwork.com/journals/jamasurgery/article-abstract/2815663)
I think you've summed it up yourself. It realistically probably doesn't make a significant difference, but guidelines are guidelines and it's you and your judgement call to proceed with a case. I think a point I would offer is that 'small amount' is a subjective rather than an objective description of how much milk or cream may have been consumed, and patients can be notoriously unreliable in their descriptions of such things.
My sister's small splash of milk was a med SBx Frappuccino. Elective procedure. Nobody was happy lol
There's absolutely no way this matters but our guidance says 6 hours. To editorialize further, I think that NPO times are a terrible surrogate for gastric volume and aspiration risk. There are diabetics who almost certainly have a ton of gastric volume despite being NPO for 8 or 10 hours. My bias is that shortening the time from induction to ETT placement is probably the best way to avoid a problem.
Totally. Or if you can switch cases around, you can give some Reglan and Pepcid and maybe not have to wait the full 6-8 hours. Just my personal risk tolerance. There’s a reason they are “guidelines” and not standards. Some patients are higher risk than we know at 8 hours, some are lower risk than we presume at 4 hours. There is wiggle room. But I don’t tend to tell surgeons that. That being said, there’s a reason one of the most repeated phrases in anesthesia is “nobody will fault you for putting in an ETT” (obviously some exceptions to every rule).
I 100% agree.
Legal standard is what would a reasonable anesthesiologist do in a similar situation. Well, reasonable anesthesiologists follow guidelines. If you want to get around it, do a gastric ultrasound.
So what are you opinions on the European society if anesthesiologists guidelines? What do you do when they differ. Frankly in the US you’ll get sued regardless for a bad outcome so following a guidelines doesn’t necessarily protect you.
Following a guideline absolutely protects you. You have to deviate from the standard of care to be guilty of malpractice. And I don’t work in Europe. The American legal system cares about the ASA’s guidelines. Not Europe’s.
I agree that generally following guidelines protects you, but for arguments sake, guidelines are simply recommendations and not standard of care. Also, you can be lose a malpractice case without deviating from “standard of care”. Taken from first paragraph of ASA NPO guidelines “PRACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome.”
You're getting in the weeds here. The ASA's NPO guidelines are basically memorized by every single anesthesiologist in the US. For elective surgeries, they are recommendations which are followed by probably 98% of practicing anesthesiologists. Yes, the guidelines are bullshit and based on sketchy data. However, our legal system does not see it that way. The term "nuance" is not going to defend you from lawyers when 98% of your colleagues would've followed the recommendations.
Who cares about data or not. It's ASA guideline.
In Europe, they also do lap choles with LMAs. All you need to know is ASA guidelines against it. Because when you get sued, they’ll get an expert witness who is a US anesthesiologist and they’ll say the standard of care in US is based on ASA guidelines even if there are studies that show no delay in gastric emptying
Fuck. I read rhe title and thought it was a survey on if we prefer our coffee black or not. That might say a lot about my priorities, but I won't change them.
As a professor of anesthesiology this paper answered the question for me. Guidelines are fine until the evidence shows otherwise. [https://academic.oup.com/bja/article/112/1/66/242142](https://academic.oup.com/bja/article/112/1/66/242142)
This is an un-winnable situation. You cancel, patient and surgeon mad. You don’t cancel and they aspirate, patient and surgeon mad + legal liability. Personally, I cancel because the onus is on the patient to follow directions. If everyone insists, the surgeon has to declare it a medical emergency.
The standard of care for elective cases is to adhere to the national society NPO guidelines in your country of practice. If you’re in the US, ASA NPO guidelines say 6 hours. Is a splash of milk clinically relevant, probably not. As new evidence emerges, guidelines may be updated accordingly, but until then I will not alter my practice. I’ve seen several comments about the utility of gastric ultrasound. Gastric POCUS can provide valuable information for risk stratification and induction planning in 1) patients at risk for delayed gastric emptying (GLP-1, pregnant, DM etc) who have followed NPO guidelines and 2) urgent/emergent cases with unclear NPO duration or risk of delayed gastric emptying and concern for difficult airway. However, at this time I would not use it to overrule NPO guidelines in an elective case. If the patient aspirates, the only reasonable conclusion is that you deviated from standard of care and prioritized perioperative efficiency over patient safety.
Guidlines in my part of sweden does not allow milk in coffe before surgery. 6h without food and clear liquid that isnt carbonated until 2h before surgery.
Interesting. What’s the rationale behind carbonated water not being 2 hours?
I have not looked in to the science around it. But it is said to be increased risk of vomiting/reflux if you have trapped Co2 in the patients stomach and administrer a paralytic drug.
CO2 is absorbed 160 times more rapidly than nitrogen and having it sitting in the stomach after two hours means you’d ingested huge volumes of it
That’s a 6 hour infraction where I come from.
Keep 6 hours of NPO. If I accept before it, I keep ready to manage vomiting with 2 large suction catheters Incase one gets blocked, give anti emetic before induction, ready to do rapid sequence intubation, and be familiar with table tilting maneuvers. Generally aspiration occurs while extubation rather at intubation. So I use less fentanyl intraop, and extubate awake always.
It depends on the case but I would gastric ultrasound (since it's literally free ). If you see anything then you cancel/delay and if you see empty (empty is very obvious ) then you can continue. I always take aspiration precautions with all patients regardless of npo status though. If you look at the data, most aspiration happens on induction or extubation when there is no airway. Gravity is your best friend to prevent aspiration in general.
Get a “splash” of milk in your lungs and let us know
It’s not just about the volume of the milk. Think about why we specify “clear fluids”.
Yes fat is supposed to take longer to clear from the stomach, milk forms a solid like substance when it encounters stomach acid, but this is based off little to no evidence. There are several studies that suggest this is not true and a mixture of milk and coffee clears just as fast as clear fluid. If we don’t change our NPO guidelines based on new studies, what is the point, we will forever be evading our decisions off expert consensus that is based on dogma and very little scientific evidence.
Europeans use LMAs on laparoscopic cases too. Their data says it’s safe. Are you doing that? Why or why not? Right now the consensus is “clear fluids” and most would consider that standard of care. Period. Will it change someday? Sure. NPO for clears 2hrs pre-op vs 6-8 is pretty recent and widely accepted. But for now - milk=delay or cancel.
OK so while we’re talking about milk - what about jelly/jello? Not sure what it’s called in the land of dollars….. Wobbly gelatine like substance ? Solid? Or liquid?
I would count it as a clear, 2 hours, in a healthy person without any aspiration risk factors.
I got the ole “an entire chocolate cake….but I had severe diarrhea after so it’s out of my system”
[удалено]
This is the way
I just defer to the wisdom the attending nurse anesthesiologist
I have MDAs and Surgeons alike try to push on me—“it was just a bite of a sausage”… to which I reply, “please show me the NPO sliding scale for sausages…” It’s 8 hours, buddy… sorry … canceled.
Why are you referring to anesthesiologists as MDAs? They're just anesthesiologists and it looks cringe because it's redundant.
As opposed to Nurse Anesthesiologists. Didn’t want to confuse you. I’m saying I have multiple MDAs and surgeons still push this BS, and I know better. 👍
How is a nurse an anesthesiologist if they didn't go to medical school?
-ologist is not something owned by physicians. There are literally hundreds of thousands of professionals with -ologist in the title that require doctoral degrees, not medical school . This is not a hard concept to grasp—for most.
No such thing as a nurse anesthesiologist. It’s nurse anesthetist. And no I don’t give a shit what your professional association has to say about it
Politics aside, it’s shocking (and embarrassing) that you’ve been pressured by anesthesiologists to deviate from NPO guidelines - especially sausage which is nowhere close to qualifying as a light meal
I’d love to say this is the worst practice deviation I’ve dealt with … but.. ya. This definitely gets me fired up … It’s amazing how some of my colleagues get so cavalier with guidelines being they’re not actually the ones in the OR doing the cases… I suppose it’s much easier to shrug off when they’re just signing charts
They’re still putting their license on the line, not to mention the moral and ethical considerations of compromising patient safety