I've been preaching that for a while.
In my career, I've had two patients aspirate gastric contents.
One was a 12 (?) year old having foot surgery. He had been NPO for 8 hours, and I did the case without an endotracheal tube. It was within the standard of care. He coughed up last night's dinner. Spent the night in the hospital for a presumably outpatient procedure. No long-term sequelae.
The other was a guy (I still remember his name, 30 years later) who had some ENT procedure. At the end of surgery, he coughed up last night's pizza. I remember the green peppers. He did not, AFAIK, aspirate, but it scared the crap out of me.
Not my case, but there was a patient who I pre-oped who had a hiatal hernia. My partner put her to sleep, and before he could intubate her, all the stuff in her stomach came up and filled her oropharynx. A goodly amount ended up going into her lungs. She died about 10 days later - in the ICU on a ventilator.
I was sued, as was my partner. I was dropped. He settled.
Instead, the new ASA guidanceopens in a new tab or window states that most patients can continue their medication up until the day of surgery but should follow a liquid diet for 24 hours before the procedure, depending on specific circumstances.
For decades we've been taught that pregnant women have delayed gastric emptying, and we should treat them all as having a full stomach. Now we're being told that it's probably OK.
I disagree.
Glad I'm retired and I don't have to make these decisions. I can't imagine going to the GI lab to give anesthesia for an endoscopy and, because the patient is on an GLP-1 agonist, arguing with the GI doc that I need to secure the airway because there's STILL STUFF IN THE STOMACH.
Sorry for yelling.
But, as they say, these days it's not my circus and not my monkeys.
There are few things scarier for an anesthesiologist than opening the patient's mouth, inserting a laryngoscope and having half a liter of semi-solid gastric contents well up and fill the pharynx.
As a former colleague of mine said (paraphrasing), "If you think the stomach might be full, you should treat it as if it definitely is."
This is a hill I would have died on.
