I was in the hospital for sepsis and the patent in the next room was going in for a bilateral leg amputation due to diabetes, his friends came in about 30 minutes before his surgery and they all did shots together for about 10 minutes before the nurse saw what was going on . I have never seen a more angry nurse in my life . The surgery was cancelled for that day also .
Several years ago I was going to have surgery and was told no food or drink, not anything, not even water. They made a point of that, repeating it 5 times. But when it came time to get my surgery, my blood pressure was high because I didn't take my blood pressure meds. They were all mad at me for not taking my meds. I pointed out that they made it absolutely 100% clear that I was absolutely not to eat or drink anything, not even water, so I didn't take my medicine. They all acted as if I was stupid for following their instructions to the letter and told me, "well, you can drink a little water to take your medication". They should have told me that before. How do you think I felt? I fasted for nothing. I was the one who was hungry, thirsty and had to reschedule and fast all over again.
Yea some medications still need to be taken before surgery (which the medical team will tell you) and it’s common practice to let patients know they can have a small sip of water to take these. That’s not your fault. In fact you’re one of the good patients who followed instructions to the letter. Most patients ignore half of their instructions.
I remember hearing a story about a dad who had to bring his young daughter in for surgery, he felt that the "no eating or drinking" rule was too strict so he let her have breakfast, she later died of pulmonary aspiration during surgery and that has scared me into listening to my doctor very closely
@13. Ghani Ziyad Sagiansyah Ah but if the doctor tells them there is a high chance of dying if they eat or drink, and then the patient does so anyway, now it's on the stupid patient who thought they knew better than the doctor.
Reminds me of the story of a lady checking in at surgery with her 10 year old son. Nurse asks if he has eaten anything in the last 8-10 hours. She says no, while the kid is eating a bag of Doritos. She gets mad when the surgeon cancels surgery.
As somebody who spent nearly six weeks in the hospital with aspiration pneumonia and a related lung abscess after I aspirated my stomach contents during knee surgery, I can attest that this is a serious and pressing concern.
@@Rust_Rust_Rust Depending on where he is from, it might be a communication problem. Here in germany, I was once scheduled to get some blood drawn at about 6:00 in the morning, the doctor told me to come in "Nüchtern", which translates to sober. I told him no problem. Next morning, I come in and get asked if I am sober - which I was. Later on, I get a call regarding the results, asking me if I really was sober. I told them yes, I haven't touched alcohol in a few months. They said that in this case, the sobriety required was from food - which I didn't know, since it was the first time I heard "nüchtern" in regards to food. That wasn't too big of an issue, since I could just get my blood drawn again, but if I was scheduled for surgery and didn't know this, and the medical staff doesn't explain what exactly they meant by that sobriety, I might see how someone can come in after having some food, and still feeling like they listened.
@@VMUDream You could actually make a word up for this, which would be valid - Frühstückslos, for example, which would mean without breakfast. Or what would be more common, but it would be 3 words: With (an) empty stomach, "Mit leerem Magen".
"She was fussing because she was thirsty, so I gave her a little juice. I didn't think it was a big deal " the dad said to the surgeon, after his daughter almost died from aspirating fluid into her lungs while under anesthetic.
In outpatient surgery, we have many patients lie about not eating or drinking. Then we find out when we extubate , they aspirate , then we have to call an ambulance to transfer them to the hospital on a ventilator. Or they lie, and feel the pressure right before surgery and say, well, I did eat a jelly bean….but usually it’s much more than they admit to. I really wish the pre op instructions would tell patients this is actually a matter of life or death that they don’t eat and drink. I think they just tell them to not eat or drink but never say why
Can confirm they don't say why, I'm watching this video because I've always wondered why. I legit thought it was because a) it would affect the anaesthetics effectiveness, and b) because they didn't want to get vomited on 😂
@@Phoenixhunter157 at work my supervisor got angry when I said you may feel pain after getting a MRI arthrogram. She said you’re not allowed to say that or patients may back out and get scared 🙄 so I have to use the words discomfort and soreness
I was wondering how anesthesia was handled with emergencies, such as appendectomies, where the patient hasn’t had time to fast before the surgery. Thanks for posting.
He didn’t really go into it much but RSI requires an OG (orogastric or mouth stomach) or NG (nasogastric or nose stomach) tube which sucks the stomach contents out of your stomach to reduce the incidence of aspiration. This isn’t fool proof which is why it is preferable to have someone fasted before anesthesia. I’m an oral maxillofacial surgeon and regularly we use the OG or NG tube after anesthesia because blood in the mouth can be swallowed and come back up which can have infectious bacteria in it due to being in the stomach during surgery involving the mouth.
no such thing as an emergency surgery. surgery is a lie. i would know i cant get it even though going without it is killing me. fuck this country so badly. also im so jealous of people that can get it. genocide in the usa.
@@drjjohnson44 This would be preceded, during RSI, with Sellick's Manoeuvre / cricoid pressure. The airway must be secured prior to inserting an NG tube. Alternatively, the NG tube may be passed with the patient awake and upright but this is a most unpleasant procedure and not always possible as time is of the essence with appendectomies, etc.
Trying to explain this to my cats before they have a dental cleaning under anesthesia is always an issue. We have to go around the house the night before and make sure that all the water bowls are taken up and all the toilets are closed. It's especially a point of argument if only one is going under anesthesia and the other has to whine and go hungry all day.
Water is usually okay to leave out, but food after midnight is a no-go. Even if the pet is fed, the premedications usually cause vomiting, so that takes care of the issue.
I have type1 diabetes and recently had a short surgery under general anaesthesia. While I was waiting before surgery my blood glucose was falling gradually and eventually I could see I was going to have to do something about it. Normally I'd just eat something but obviously that was out. I let the nurses know about the situation, thinking it was all going to be pretty simple, since to me this is a completely normal kind of situation and I knew exactly what needed to be done. But I forgot that's not how things work in a hospital. Any time someone has Type 1 diabetes everyone seems to completely panic because it's just something they only have to deal with rarely. I know they just needed to give me some IV glucose but the nurses have to go and find a doctor to make the decisions. The doctor turns up, starts asking me questions about what symptoms I'm experiencing due to low blood glucose, I have no idea why! She decided they were going to start sliding scale treatment (IV glucose _and_ insulin) which is used when a patient can't manage their own diabetes for whatever reason. This was about a 2 hour surgery so definitely not required in this case. Anyway, the hospital had just got a new computer system so the nurses were trying to work out how to log the medications on the system, and whether to start the insulin or glucose first. When I heard that, I couldn't quite believe it! At this point I've been hypoglycaemic for an hour, getting worse and worse, and now I'm hearing they're going to start giving me insulin?! I'm normally a pretty chill person, but if you've ever experienced being "hangry" you can probably understand my getting a bit more assertive sitting there with a blood glucose of 2.5 (45 in american units) Doctor was long gone by that point so I just told them to start the glucose now and we can talk about the insulin when I'm not about to expire, which they did. Half an hour later I'm feeling much better, apologised for being short with them, and with my brain working again I was able to explain that I didn't need any insulin and the problem was sorted now. But what a rigmarole! honestly if they hadn't been watching me the whole time I think I would have just eaten 20g glucose and sipped a mouthful of water. I think really that would have been the best option too. The glucose would have been completely absorbed, leaving nothing in the stomach. But I appreciate there are procedures that are designed to cover the majority of situations and be simple enough not to leave open the possibility of confusion. Having Type 1 in a hospital situation is a nightmare because you're used to dealing with this complex condition all by yourself, and become an expert. But then you go into a hospital and suddenly somebody else is in charge of it all, and they don't actually know what they're doing. If you have type 1 and you're going into hospital for any amount of time, I recommend insisting on seeing the diabetes specialist so you can have a conversation with them, work out how the condition is going to be managed, and then they can advocate for you with the medical staff.
I provide my surgical doctors a simple list of requirements. On the list: Since I am able to keep my BG below 10mmol/L or 180mg/dL, they can too. ( I awoke from a 7 hour cholesteatoma removal surgery with SEVERE thirst and vomiting (and pain). Demanding fluids, then vomiting, rinse and repeat. Why? Because my BG was 40+ (too high for my glucometer but not the lab). Absolute incompetence. I will never let that happen again...the pain from the head surgery combined with vomiting. I felt like I was going to pass out each time. Also on the list: - saline IV only (or LR, if absolutely required). No glucose in the general IV bag. They can add a bolus of dextrose when and if it's needed. Once I am awake and functioning I will take over ALL insulin administration. There is only about 6 or 7 things on the list and none of them are really all that demanding. I have only self admitted to the ER once because of hyperglycemia (pump failed without me noticing for 12 hours....I was happily drunk and then sleeping soundly, LOL). Because of the new symptoms, I went to the ER. They were treating my severe hyperglycemia with regular insulin and glucose in the IV. I was upset. Very upset. I called my Diabetes doc (internist) and he unofficially recommended I leave "against medical advice" and treat at home. So I did. The hospital can be a very unsafe environment for an insulin-dependent diabetic. Training needs to improve. Too many horror stories.
@@paulenriquez8307type 1 diabetes is an autoimmune disorder where the pancreas is attacked by the immune system preventing insulin release. They have to use artificial insulin for life once the diabetes is present. They must also monitor their blood glucose levels in order to ensure hypoglycemia or hyperglycemia do not happen as either can become fatal. Type 2 is sometimes curable through diet and exercise, as it is caused by insulin resistance instead of a lack of production.
A friend of my dad's has a story related to this. He was set to do surgery on a little girl, about 7 or 8, and instructed her parents not to let her eat anything from the night before the procedure. While on the operating table, she started vomiting, and went into cardiac arrest. It turned out that, since the little girl had been complaining that she was hungry, her parents had decided some eggs for breakfast would surely be fine... right? In the end, they managed to bring the girl back, but that story has always stuck with me.
It didn't happen to your dad's friend, you read it online lol. Such a fucking weird thing to lie about to feel special. Might as well have just said it was your friend, would have made no difference.
Thanks for the information. I'll start taking those no food or drink orders more seriously from now on. I've had quite a number of surgeries for a number of different medical issues. Usually I do refrain from eating well in advance, but I do occasionally sip some water before surgery. I always thought that no food or drink order was to prevent nausea. Never realized it was all about aspiration.
It may not prevent nausea (I had terrible dry heaves with mucus after my surgery, side effect of anesthesia drugs) but it probably helps a whole lot with not having to clean up a huge mess afterwards.
I think it's odd that people don't listen when they're told not to eat or drink anything before surgery. Why wouldn't you listen? They tell you that for a reason, even if you don't understand why.
How about the ones who are supposed to quit smoking before surgery, and don't? People have lost fingers, etc. due to poor circulation caused by smoking.
I had an emergency appendectomy when I was 18, in 1980. A couple of hours before my symptoms became bad enough that we headed to the hospital, my mom got me to try eating a light lunch to see if it helped. The first thing I heard when I woke up in recovery was two orderlies speculating about whether it was half-digested chicken soup or chicken salad they had just cleaned up. I signaled my return to consciousness by croaking "Soup". 🙂
We had a patient come in for a tilt table test. I asked her when she ate last. Answer was, about two hours ago. What and how much did you eat? A plate of liver and onions with mashed potatoes and a coke. She got rescheduled! I had a chat with her about why it’s important to not eat prior to this test. There is a risk of aspiration should a patient lose consciousness. I have been in other situations where the patient says they’ve not ate but during a procedure the truth comes up….literally! All we have to go on is what the patient says.
I've had issues vomiting during procedures even when not eating for 12 hours prior, due to severe issues with my LES and severe GERD, usually vomit up stomach acid/bile/liquid.
WHAT lol I got a tilt table test and I was allowed to eat and drink 😆 Everyone I know who got one did so BECAUSE they frequently pass out, we're not walking around on an empty stomach all day 🤣 Dysautonomia fainting spells last like 3 seconds I'm usually awake the second I hit the ground
My father had a quadruple bypass in 1990. He died from pna from aspirated stomach acid. Back then they didn’t have the cuff on the endotracheal tube, so it just flowed up. Ironically, his heart was fabulous, sepsis killed him😢
I’m glad I followed the instructions well! I had my surgery at 12:30 in the afternoon, didn’t have anything to eat since 6 o’clock the night before, even very little or no water after midnight. All I really had the night before were a couple of cups of kava stress relief tea, and a melatonin. No caffeine since early morning, and certainly no alcohol in three days.
I've had a number of procedures where I had only been allowed a sip of water the day of surgery in order to take medication. It isn't as bad as it sounds and much better than having serious issues as a result of eating a 4-course meal before an 8-hour surgery My surgeon used to not eat or drink anything when he had to do longer (6+ hours) surgeries like mine
I know that when you're going to surgery, you're forbidden to eat or drink anything, but i never know that it can life threatening. Thank you for your video. When i was going for surgery to remove a metal pin on my broken arm, my surgery starts at 4pm, i was fasting from 8/9am i think, and on 3pm i'm feeling really thirsty that makes me really want to drink a mineral water, my thoughts at that moment was "it won't matter too much right? because it's just a regular water", but then for some miracle i didn't take it and endure the thirsty feeling. Thank God my surgery was successful.
I had a really fun experience with anesthesia last month. I have a multitude of sleep disorders which always get the anesthesiologist’s interest. Anyway, I remember being taken to the OR, being given two syringes of stuff and being asked “are you getting tired yet?” I said no. Then we talked about Whitney Houston who was playing in the PR and how no one in the room seemed like the Whitney Houston type. Then another anesthesiologist showed up, told the original anesthesiologist to skip to the fourth syringe while he drew up some other stuff. Finally I was out. I was quite the topic of discussion in the PACU. Fun times. 🤘🏻
Great video. I've always gone extra time, for fasting, and I fast 2 days prior to surgery. That's 2 days prior, and day before, with only broth, jello, water until 10 hrs prior to surgery. Then only water on evening before, stopping water 8-10 hrs prior. Anesthesiologist and surgeons are always thrilled when I tell them I did this in the pre-op. Limits post surgery nausea, too. Some people, it takes a long time to completely digest. Some can't do this if they're diabetic. Otherwise, I swear by my fasting technique. Jello is good.
As someone who type 1 diabetes I was allowed to drink a small sugar drink 30 minutes before I had a big heart surgery it was more important to prevent a low blood sugar. As having a low blood glucose under general anaesthesia is more dangerous
When you have a scheduled planned surgery, you always have to get cleared for surgery by your physician and they do bloodwork and make sure that you’re healthy.. i had a tympanoplasty and had to have all the tests done before the week of
I enjoy your videos and anesthesiologists play an import role to the patient’s mood going into surgery. I’ve had 15 surgeries, 14 I remember. There were two with the same doc and the second surgery when I got to the operating room it was the same anesthesiologist. He was so nice and fun the first time, and this was so much more serious, complete bowel obstruction with sepsis, I was so glad to see him. You seem like a fun one to start off in the operating room with.
Thankyou for explaining! I am still baffled at people who don't take this seriously or feed their children before surgery. Like, we get it, its difficult to go hungry for 8 hours, especially for a cranky child who doesn't understand, but its only temporary and they will not die. When I was a teen, I was in the childrens surgery unit for day surgery and I was in a small cubicle waiting for anesthesiologist, another family was next door with parents and a 4 year old boy, the doctor asked them clearly, "has your son had anything to eat or drink in last 8 hours?", the father replies, "no, but 2 hours ago he had some toast and scrambled eggs"... the doctor went silent, um... genius man, scrambled eggs and toast is FOOD! In what world is toast and scrambled eggs not food?? The doctors cancelled their surgery, rightfully. It seems like many parents are okay with the serious risks than to hear their whiny brats cry and complain... anything to shut them up I guess.
I dropped my daughter off for oral surgery a few months ago and at the checkin was a man telling the nurse “by the way, I had a coffee this morning. I simply can’t function if I don’t have my coffee”. She told him he definitely wouldn’t function after the surgery if they went forward. Obviously the surgery was cancelled and he could not understand why. He just wasn’t understanding how serious it was.
I had jaw and genioplastic surgery as well as forehead reconstruction a year ago and being already underweight I think the lack of food prior and difficulty eating post surgery has definitely made the side effects and drowsiness of anaesthetics a lot worse
Reaction per amount of body weight is on a bell curve. so 10% of the population like me need truck loads to be put under, and 10% can need as little as 50% of the normal dose. If you need another operation I suggest eating loads of low GI carbs the day before, plus some quality protein and a large male will need about 6oz (160g) of actual protein over the day which is different for each source. EG meats have more in (per oz) than most vegetables. If you are a veggie, then a veggie chilli pasta works though pasta is not ideal GI wise. Raw carrot can be excellent for that as can most types of cooked beans.
Good info as always Max, thanks. By coincidence, yesterday, I received my new bilateral ureter stents - the sixth set of them in 2 .5 years. Anyway, it's a relatively short (about 40 minute) simple procedure under general anesthesia with no incision required because it's done through the urethra. I followed all pre surg guidance: nothing to eat or drink after midnight except to drink 12 oz water 2 hours b4 arrival at hospital at 5AM. Procedure began at 8AM sharp with me "counting by 13's" just for fun. I made it to the 12 iteration (156) before succumbing to the anesthesia. There were no issues were the procedure and I was discharged at 9:45 AM.
Not sure how or why this video was recommended by TH-cam but I enjoyed it. It's informative and it's something I never thought I'd want to know until now.
This is very helpful. Wish that explanations were routine. I have a congenital dry throat and so not drinking is basically impossible. Have found that using a hiking trick (sucking on a small rock) makes it possible for me to not drink before surgery. The look on the face of the person asking if I have anything in my mouth (they're thinking dentures etc) ranges from baffled to "no, I didn't hear that" when I say that I'm suckling on a rock. By the way, this is a common thing to do in a desert climate but I now live in the east,
The funny/sad thing is healthcare workers can explain exactly why ignoring directions can lead to death but people will still ignore them thinking they’re the exception.
No, they deserved it. If you don't listen to a doctor's instructions for what to do and you die, that is your fault. You should have listened to the doctor.
No one deserves to die because of it!!!! But they should certainly listen so they do not!! Your comment was pretty callous u think a child under the parents control also deserves death?
For an emergency surgery, would it maybe be beneficial to pump the pt's stomach to clear out anything that might be in there, reducing the risk of aspiration?
Truly a side note on this is gastric emptying. I had a gastric emptying study done several years back and the radiologist (with decades of experience) stated that she had never seen someone empty so fast. Every ounce of what I injested was completely clear of my stomach within an hour. As a physician I know it will not be TMI to you but to others I must warn... It is the reason that I have a BM within 30 minutes of eating any true meal (most times within 15 minutes). My wife had gastric bypass and was warned about (and if she eats the wrong thing she gets) "dumping syndrome." I naturally have "dumping syndrome" and have so all my life. So myself could go under within an hour of eating a full meal and not stand a chance of suffering any bad outcome. A normal person could wait a few hours, and on the other end someone that has delayed gastric emptying could have to wait 6, 8, or even more hours. So I agree, and the standard of care, is to err on the side of caution, and to say 8 hours fasting.
I guess I'm on the other end of the scale. I was going in for a gastroscopy, and was told to fast for 8 hours. I did listen to the instruction, and didn't eat anything after going to bed the night before. After the procedure the doctor asked me how long it had been since my last meal, since they had found food still in my stomach. I told him the truth: 15 hours. I walked out of there with a gastroparesis diagnosis (which I already suspected) This video showed me I should really inform my doctors about that if I ever need a surgery. I clearly must fast more than 8 hours.
@@bflyw74that's how I was diagnosed with gastroparesis, too. Had an upper endoscopy to figure out why I felt so awful, and there sat my dinner from 14 hours previous.
I'm from the UK and I've had surgery a few times, I never quesioned why I couldn't eat before surgery I just always trusted that the doctors knew best and followed any instruction.
Great video man! Great info! I learned a lot!! That was amazing and awesome! I have had 14 surgeries because of my cerebral palsy! I don’t eat because surgery! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy! I really wanted to be a anesthesiologist!! You rock man! I like your shoes
I love your positivity. I’ve had 4 lung surgeries myself and I have really learned that staying optimistic, and sometimes stoic, is the only way to be able to go through it all. Keep it up ❤️
I've become accustomed to surgeries done under local anesthesia. There's definitely some advantages. I've even asked for water and stuff and they accomodate to make me feel more comfortable.
I'm like that too. And for dental procedures I usually ask if they can skip or minimize the local anesthesia as well. The next surgery I'm scheduled for they seemed very reluctant to do with local only anesthesia. It's just removing a fatty cyst from the back of my neck. I understand that they are afraid of my moving around during the procedure and that it's a rare thing for the patient to be able to tolerate being cut while fully conscious.
The easiest answer is due to the anesthesia if you ate or drink anything, there's a high risk of you puking but because you're effectively placed in a deep sleep, it suppresses your gag reflex along with the numbness. So you would suffocate on your own vomit to death.
@@MaxFeinsteinMD exactly. If you have to barf, your body gradually brings you to wakefulness so that you feel the nausea and know youll barf. At least that’s been my experience when I’ve had stomach virus (which always seems to occur in the wee morning hours for me. lol)
*Thank you so much for this video!!!* I'm glad I saw it. I have a habit of listening very closely to my doctor and doing whatever she (or he) says. When they say Fast, I FAST! They say nothing after midnight, so I have nothing after 6pm to make sure I'm empty. It's wonderful to see this video and realize my OCD has been contributing to my making it through surgeries. 🤗🥰
can you do a video about anesthesia vs a medically induced coma? How do you put someone thats in a medically induced coma under general anesthesia for surgery?
I remember as a kid in the 90's being allowed a clear breakfast before surgery. Usually Jell-o and apple juice. I'm curious if this is still a common practice for pediatrics, and if so, why are the standards different?
This was a really informative video. One thing I've always wondered is why a King tube is never used by default as it does a decent job preventing gastric inflation and aspiration while still maintaining a patent airway.
I JUST HAD SURGERY LAST SAT AND WOKE UP during it with general anesthesia. I was facedown and no one could tell I was awake. I’d like to see your opinion on this. I had paralytic agents on board so I was unable to move although I was trying SO hard!
I'm surprised they couldn't tell by things like your heart rate! There are other ways to tell, from what I understand. I'm sorry this happened to you and I wish you all peace moving forward from may have been a very traumatic experience.
@@Kait2478 it felt like a very long time but I’m sure it was prob 10-15 seconds. I felt like I was choking and gasping for air (I know vent was on but I was panicking!!!). GREAT observation though about the Hr. Never even thought about that! Idk what the heck happened. I know when I next woke up in PACU- I was pissed as hell and expressed it and the anesthesiologist actually said ‘it was near the end ‘. Bedside manner was garbage!! Unfortunately, we don’t get to pick anesthesiologist when having emergency surgery, or really any surgery for that matter!
@@GhostPepperMeg There was a Grey's Anatomy episode where this exact thing happened. In that episode they were also reluctant to simply apologize for the experience. I'm sure it would have gone a long way towards giving you healing and closure for you, too. It would be interesting for an anesthesiologist to weigh in on your experience here.
I really appreciated this video. Everything you spoke of made sense to me. Maybe because I have a lot of issues with choking currently (neuro and eds related so waiting to try and sort it) and also waking with choking thanks to mucous from mast cell reactions. It’s not all the same BUT has a similar issue and then having gastroparesis, very experienced in trying to keep stuff out of my lungs! Thanks for explaining so clearly and showing us with drawings etc. I also appreciate that you speak about what is done now especially considering prior literature but what current literature says and so why it might (and probably should) change in regards to RSI’s. I’ve always followed the rules and now I’m definitely glad I did! Thanks 😊
I've seen people claim that the reason people aren't allowed to eat or drink during labor is in case they need an emergency C-section with general anesthesia. But most C-sections aren't done under general anesthesia, so some people claim that the rule is outdated and that it's worse for people to not be allowed to eat or drink at all when labor is such a strenuous event. As long as they know the risks.
Hi Will, you are right that food/drinks are restricted due to the possibility of an emergency C-section with general anesthesia. You are also right that *most* C-sections aren't done under general anesthesia. However *some* are, and those tend to be true emergencies which could be made potentially fatal if a patient has eaten.
Great to see the "X hours before surgery" advice and the "more hours for food than for water" advice. In the bad old days they would tell you no food or drink after midnight the day before. whether you were going under at 8AM or 6 PM.
I had cancer surgery 3 years ago and it was nothing allowed after 10pm! Then at 6 am they made me take a Benadryl by mouth with just a sip of water to reduce allergy possibilities. It felt stuck in my throat so the kind anesthesiologist told the nurse to give me a little more water. As they knocked me out my thought was 1) I changed my mind about surgery and 2) hope I don't aspirate. Then I blacked out.
I had two surgeries under general anesthesia in 2021 at a large health system hospital. The pre-op instructions stated no food the day of surgery, but I was allowed to have a few clear liquids the morning of surgery. I don’t recall the entire list but I do remember being allowed to have water and sprite.
@@ashewastakenTT after midnight for liquid is outdated and causes more harm as patients are dehydrated, more irritable etc. And actually when you give a normal stomach liquid, it causes it to empty faster so that's why they say within 2 hours. For some pediatric centers they say 1 hour is also fine for liquids
@@No-xh2csUMC Utrecht lets you drink until you go in. They say it is no problem and not any less safe. One of the best hospitals in The Netherlands so I believe them
Marsman, M., Kappen, T.H., Vernooij, L.M., van der Hout, E.C., van Waes, J.A. and van Klei, W.A., 2023. Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety. JAMA surgery, 158(3), pp.254-263.
I’ve got gastroparesis and im jej fed. I’ve had aspiration pneumonia (I have GORD too and i refluxed in my sleep one night, had my cat not gotten into my parents room my mum wouldn’t have heard my strange breathing and I’d probably be dead) and it had me in the ICU for a week. It’s both terrible and I felt absolutely awful. Also get hypos. So I just let the admission nurse know and they can have glucagon on hand. It really isn’t worth the risk!
Anesthesia scares me ever since my last time under. I have an issue with my right hand and last time I went under I had alot of dental work and when I woke up my hand was super purple and I couldn't move it otherwise I was fine. I will never forget to tell them about that if I ever need it again. Still freaks me out like two years later. I believe I have a collapsed vein in my hand that makes my thumb and pointer finger constantly a little swollen. Doctor said it was either a vein or lymph node issue but guessing how it reacted it's a vein issue.
I totally understand and accept that you should not eat or drink BUT only speaking about the UK NHS, they instruct all patients to follow the same rules as if they were first on the list. I have had the unfortunate experience of not being taken down until very late, I was too anxious for food but thirst was a major discomfort. My son had an even worse experience, just falling off the list so he was removed and rescheduled, but because this was likely to be because an earlier patient had complications or for a medical emergency, it was necessary. It would have been so much less stressful for updates on possible theatre time, and it would have been so much more humane for permission to be given for water to be allowed if surgery has to be delayed. I do not know if other countries manage their lists and pre operative patients more humanely.
Just thank you for all of the time and effort you’ve put in these videos! I love all things health-related and particularly love how easily-digestible your content is.
My wife is currently in hospital (in the uk🇬🇧) due to an unrecorded hietes hernia that allowes aspiration during a lung and liver biopsy (key hole surgery) As a result she was intubated for 23 days (so induced coma and paralysis) then had a tracheotomy for 2 weeks, currently a feed tube into the lower intestine and and a stomach drain (small tubes in/out of the nose. Today she is scheduled for the hernial operation, and hopefully a final path to recovery. Was admitted on march 27th and still in, was on icu for 30 days. While she didnt eat before here key hole op, its a real life case study into what anesthetic and gas introduced in to the body for a routine procedure can do if there is a hidden weakness waiting for them.
OR nurse here. On more than one occasion, we found out a patient lied about their fasted state when they aspirated stomach contents on extubation (removing the endotracheal tube). They ended up in ICU. Play stupid games, win stupid prizes.
Thank you so much. I broke my ankle 6/2020. I waited inpatient for three days while inflammation decreased. Food and water was not held. I went into surgery. Woke up from orif surgery feeling good ( on pain meds). I went to sleep and woke up five days later in icu with severe icu psychosis. It was terrifying. I learned (after being told by several people “wow it is a miracle you made it” I aspirated. Developed pneumonia, sepsis, had heart and lung failure. I was on a ventilator for five days. They didn’t know if I would make it; as I had trouble coming off the ventilator. Max thank you. I understand better because of this video. I became terrified when I have to go under general anesthesia. (I’ve needed further ankle surgeries.) For the love of God, thank you. My ptsd is relieved. Now I know no food or water. Not even a tiny bit. 🫶🏼🫶🏼
I'm glad you're better now! I've had aspiration pnemonia 4 times (not from anesthesia, but gasping for air while vomiting violently), and have permanent lung damage. I joke to people that "intelligent design" was made by an idiot... who puts the eating tube in the same place as the air tube of the body??
The hospital didn’t have you npo ( refrain from food and water) before your surgery?! That is negligent. Attempted murder. Dear god. I’ve never heard something so bad. I’m sorry
The anesthesiologist didn’t ask you when was the last time you ate/drank? If not, what backwater were you getting surgery…did you jump in Time Machine and travel to 14th century? Or did they ask you and you weren’t 100% truthful?
I could watch a whole video on RSI in a variety of emergency situations. I'd love to hear you explain how intubation would proceed in a case of anaphylactic shock.
Same here! I’m a carpenter and I found this channel after being put under for knee surgery and came out feeling like I was beat with a bat the following day. Had hand surgery and came out feeling great just wanted to know why I was hurting the first time and not the second. Maybe that’s why I’m a carpenter and not a doctor. 🤷🏼♂️🤷🏼♂️🤷🏼♂️🤣🤣🤣🤣
Seen multiple surgeries cancelled because the meal service guys miss the NBM sign by the bed, give the patient food, the patient thinks "well if I've been given it it must be ok" and hey presto, they're off the list for the day. Doesn't matter what they've been told by the anaesthetist, or the nurse. I think it's because patients abdicate responsibility when they are in hospital, they have limited understanding of the more complex stuff, so they allow every decision to be made for them, and if they get food, no matter what they are told, they assume somebody who knows more than them has made that decision to feed them and it must be ok.
I have gastroparesis and intestinal dysmotility. The last time I had a colonoscopy (with propofol anesthesia), I had to be intubated. This seems really unusual for this type of procedure. Even though I followed the directions for drinking the colonoscopy prep solution, a significant portion of it was retained in my stomach up to the time of the procedure, and there was concern for aspiration risk. It was really scary.
Hello Dr. Feinstein - imo, this video is TRULY one of your best ones ever! The way you have explained why NOT to eat before surgery could very well save lives!! EXCELLENT video!! Should be used in classrooms in medical schools!
Can you comment on the prohibition of eating or drinking during labor? I read a Twitter thread recently by Mama Dr. Jones where an anesthesiologist was saying it was definitely necessary because of the possibility of general anesthesia later, but apparently the medical literature doesn't support fasting during labor, since it can extend the period of pushing and delay delivery, and the chances of undergoing general anesthesia for even a C-section are pretty slim. Seems like a huge oversight in the field that affects a lot of people if it's not actually beneficial in any way.
Definitely recommend fasting because there is no way to predict the chances of needing an emergency C-section ahead of time. In many cases patients that are completely healthy may need an emergency C-section. Even if they are not intubated, the medications given through a spinal or epidural for the C-Section can in many cases cause nausea and vomiting. Pregnancy already makes the risk of aspirating even higher than any other patient group. Having a higher degree of acid in those stomach contents can increase the risk of damage with vomiting.
Surely the chances of needing general anaesthesia for a regular delivery with no complications are low enough that this is way over the top? I can understand this being policy if there are issues that make this more likely, but it seems like an unnecessary cruelty to me! I can see why an anaesthetist might have this opinion, since they deal with "medical procedures" so to them, giving birth classes as a "medical procedure". I don't think most births count as medical procedures.
@@jhonbus The problem is that there is no way to predict what complications may arise. Perfect healthy patients can suddenly need an emergency section at any point. Imagine cases when the umbilical cord wraps around the baby's neck, or the shoulder getting stuck in the canal, or even just plain old no changes in the cervix. When comparing the risk of aspiration vs. the struggle of not eating or drinking for hours, it's a matter of risk vs. benefit. Doctors don't just stop you from eating/drinking out of cruelty. It's because that is what is safe. It's also not a matter of general anesthesia alone. A spinal in an uncomplicated c-section can cause nausea. An epidural is an anesthetic procedure that can cause nausea and vomiting even if it's for a normal vaginal delivery.
@@osamasayed4110 Mama Doctor Jones' new video (you can search it, I don't think TH-cam will let me post the link) was pretty clear there's very little data supporting the practice of fasting during labor. The UK and New Zealand do not practice this at all and their obstetrics outcomes are a lot better than the U.S.
I've had several operations, all in different countries (by some karma joke or something), but only before a broken ankle operation in Japan, I was pulled out of my room by an anesthesiologist, was explained everything I needed to know about being "put out", risks and all, asked if I had any concerns or conditions I wanted to report, and was finally asked to sign a paper that I understood what was going to happen to me (not a waiver). It was really reasuring, because someone took the time to come and tell me all details I needed to know, answer questions, and make sure I understand and feel secure (unlike other experiences that far). From my previous operations, I was already aware of the fasting prosedure, but that lady even made sure she was crossing language barriers. Still not recommended experience ;)
The RSI part of the video raised a question for me, that may be beyond the scope of what you like to cover. How quickly do hospitals and doctors change established procedures due to new information from studies? One study probably isn't enough to change minds, but does it make doctors hesitant? I am assuming part of it would depend on the thoroughness of the study and the impact on care suggested by the study.
It depends on a couple of factors (and I´m sure I have missed some): the quality of the study (randomized, double blinded placebo-controlled multicenter study versus retrospective case analysis or worse), application to your patient population (if you have a study pertaining to children, but you only treat people above 60yrs), the impact a change has (for quality of patient care, but also financially and time needed to perform) as well as spread of information (publication in a well-read journal versus hidden in a paragraph in some obscure book) - and nowadays lso if there has been a prominent law case tied to this (maybe the fastest way to force a change). E.g. Cricoid pressure ("Sellick´s maneuvre") is considered obsolete (difficult to perform correct, worse view and therefore prolonged time to secure airway, and actually further decreases esophageal sphincter tone thereby increasing aspiration risk) by most European anesthesists now, but at Max´ hospital it´s obviously still performed in RSI...
they always say doctors are sooo busy and have no time to do anything else other than working in the hospital. but surprisingly Max has time to make videos.
@@MaxFeinsteinMD I get that, Dr Max. But you know, sometime the media said: you guys (doctors) have no time, no time to take a lunch, no time to take showers and no weekend etc. Maybe just case-by-case basis.😅😅 But anyways, I am happy for you no matter what
I had oral surgery recently, and once I was awake and alert, I thought ‘I could eat’. I was given an Ensure, which was good enough to hold me over until I got home. But I was starving beforehand!
1:00 Thank you so much for saying this! Many medical youtubers tend to put emphasis on going to your doctor if you have any worries, or that it is always better to have your doctor diagnose you, but they miss stating that, at the end of the day, they cannot make a medical opinion because they are not seeing you! It might be a small thing, and many people might think it's not that big of a deal, but just as there are people that would rather have some snake oils because they saw it on youtube or facebook, there's also people that look at medical channels when they have any concerns, watch them, and get to the conclusions about their conditions instead of going to their physician.
I clicked on this because I'm pregnant and planning a c-section, and I also have hyperemesis and I get severely nauseous if I wait too long to eat, basically if my stomach is empty at all. I can manage mornings now, but I dread going in for my surgery and I really hope they can schedule it for FIRST THING in the morning. My first baby, I went into labor spontaneously, but my baby was breech. I was informed when I checked in that I would have to wait 8 hours from when I had breakfast, or until I couldn't hold off any longer (if the baby came before then, for instance). When I was checking in, they asked what time I had eaten my cereal, and I couldn't quite remember. The nurses at the station kept trying to wink wink nudge nudge me to say it was later than I was guessing, for my sake because they didn't want me to have to wait so long in labor, but it actually really bothers me now knowing the risks of why that protocol was in place. If I had needed general for some reason and got to go into surgery sooner than the 8 hours because of a lie, I would have been at higher risk, without having had that risk explained to me. I'm a huge proponent of giving people INFORMED consent, and I think someone with that level of medical knowledge should've known better than to advise me in that way, despite whether they thought it was in my best interest.
last time i went in for a surgery (ovary cyst) the surgery team was pretty chill with the fact i did need some water to get the pills i needed to take down my throat
A stomach with contents is an aspiration risk, it may get into the bronchioles and cause a blockage and atelectasis. An empty stomach rules out these. That is why patients have an NPO (Nil per os/nothing by mouth) order at least 8 hours before surgery.
Don’t you just love the patients who deny eating until a little midazolam and then they would confess to having a couple of sausage biscuits just before getting to the hospital. Any personal opinion on the use of cric pressure? Re: Anesthesiologists & THEIR positioning; bringing a couple of pillows for under their legs and some extra warm blankets along with the nicest, anatomically appropriate chair from the OR Director’s office … isn’t that in your OR’s SOPs?? I loved your video discussing music in the OR from awhile back.
This is one of my favorite videos of yours yet, Max! It's super informative with the drawing (shoutout to Mitch!). When you started doing the ultrasound on yourself I was like, cool! Then you make this ghetto bed with a chair and put your feet up, I was giggling pretty good. I almost feel like 3-5 years from now you're going to start breaking the rooms down to teach us things if this keeps up! XD
I had an emergency caesarean section delivery. Before going under anaesthesia. I was given something to drink. Can you tell me what this might have been and why was it used? Thank you.
When I had surgery in 2013 (hysterectomy), my surgery time was in the morning at 9 or 9:30 or so. I was allowed to eat and drink like normal until midnight and clear liquids overnight until I think 4am. I took that very seriously and even overnight I wasn’t drinking much even though I was allowed to. In the surgery prep I was given some prophylactic antibiotics along with an oxycodone and naproxen (standard procedure for that type of surgery to lessen the risk of infections and have a bit of help pain management wise when waking up) and used as little of the water as possible to swallow those tablets as I happen to be pretty proficient at taking tablets with little or nothing to drink. The anesthesia team kinda looked at me like I’m an alien because I needed so little water to take the medicines (we’re talking maybe about a tablespoon of water) Just better to be safe than sorry…
Thanks for explaining! I have surgery today to get my collarbone fixed, haven't had anything to eat in like 14 hours and still have another 9 before the surgery. I hate this feeling but I'm sure I'd hate dying over a bowl of oatmeal more lol
Last year I had a hernia repair under general anesthesia. Doctor gave me orders not to eat, 12 hours prior to surgery and not to take my type 2 diabetes medication. I get dehydrated easily and asked if I could drink a small amount of water and that was okay up to 4 hours before surgery and to urinate as frequently as I could while hooked up to IV an hour before surgery. Surgeons orders are to be taken seriously.
So the primary risk of aspiration is during the period between when the patient is anaesthetised and when the cuff is inflated on the endotracheal tube? Is there no oesophageal equivalent of the cuff? And is any kind of gastric suction ever used in emergency situations?
Great topic. Here’s a question. Can any of the general anesthetics given cause hiccups post op? Was in for a ureteral stone laser ablation on Tuesday and hiccups started last night on return home. Hopefully these are self limited. Enjoy Sinai. Did a preceptorship with Jerry Way back in 2005. Great GI Doc.
Thank you for explaining. I've been in anesthesia many times (22 I think) and knew roughly why I couldn't eat, but this clears things up a lot, Thank you :D
Ive had numerous surgeries in my life and I had one Anesthesiologist came into my room and said me O.K. What did we have for Breakfast this morning very sarcastically I told him nothing becauseI knew I was having surgery. I guess he deals with a lot of people that don’t understand you shouldn’t eat before going under for surgery.
i've been under countless times, i have this information seared into my brain! so much so that when my cat needed a dental cleaning i made sure she fasted even though the vet hadn't told me to. she had a long wait once at the vet's office, so if i was wrong they could give her food and water if needed. when i got there they told me i didn't have to do that, which is still strange to me! ah well, it went smoothly either way.
I had surgery on my mouth and throat 4 days ago to repair a gap in my palate. I couldn’t eat anything after 2:30am but I had a drink before 6:30am because I couldn’t drink after that time. Surprisingly I was able to have small sips of juice before I went into surgery and I was ok even though I was given a medication which sedated me before I had the general anaesthetic which put me to sleep because 30 mins before I went to surgery I had the sedative and I was normal at first and after a few minutes I was spaced out and didn’t even wake up until I was in recovery.
it's not true at all because hours before the D day they received such a copious meal that when they were going through the enlish channel a lot of them instead of fighting were seasick, bringing up and that cost their lives and it was one of the greatest blunder
Interesting video. I never knew it was a life or death thing. As a patient with no medical expertise, I thought patients had to fast to prevent them from throwing up once the anesthesia kicked in.
I have a History of Hydrocephalus (fluid can't drain from my head) and I was in the hospital once for surgery, and the nurse told me to take my anti-epileptic medication before surgery. I wasn't able to keep anything down at that time because of the pressure in my brain but I took the medication like she said, but I ended up vomiting it up in Pre Op. I knew that would happen, but I just did as she said
Idk if anyone will read this, but as a nurse in training for me the question now shifts to the ICU patients. They are intubated and all their reflexes are shut off (for some, depending on medical condition). Now they often get artificially fed still through the stomach. Why is it then, that the ICU makes it work for patients not to aspirate the whole time, while surgery needs to keep a very close look on it?
When they give the order to not eat or drink for twelve hours, it would help a lot if they included this video. The Dr/nurses have never explained why. They just expect blind obedience. Thank you for the explanation! 👍👍👍
My best friend did this. She had some problems with anesthesia. She didn’t eat but drank a bit of coffee ☕️ we think, a couple hours prior to and early AM surgical condition. As soon as they intubated her she coded! 45 years old! (Aspirated while being put to sleep) It absolutely scared the hell out of all of us. She rescheduled the surgery and didn’t consumer anything this time. And everything went fine. Thank God! Absolutely don’t do it! Especially if you have acid reflux. Lastly, if you are extra concerned. Don’t eat anything after 7 PM the night before your surgery. I always think it is a good idea to HYDRATE a few days before, so your aren’t a little dehydrated before surgery day. So drinking plenty of fluids (water 💦) like 6- to 8 ounce cups or bottles a couple days before your scheduled surgery helps ensure your veins are full and standing up plump so they can easily access your veins for IV (for medication and other treatment). Be a good patient! Don’t risk your life or be dishonest to nurses or doctors. Be honest. If you mess up and forget when you eat something, just tell them so they can reschedule your surgery. Good luck.! 🍀
I was in the hospital for sepsis and the patent in the next room was going in for a bilateral leg amputation due to diabetes, his friends came in about 30 minutes before his surgery and they all did shots together for about 10 minutes before the nurse saw what was going on . I have never seen a more angry nurse in my life . The surgery was cancelled for that day also .
As a son of two anesthesiologists I don’t find this funny at all. I would be angry along with the nurse.
Good lord…. Such a waste of time and valuable resources
His friends must want him to die. That is awful
Bilateral leg amputation? Jesus christ. I'd probably be doing shots too in that case...
@@DSlav2488, JESUS wasn't on staff there.
Several years ago I was going to have surgery and was told no food or drink, not anything, not even water. They made a point of that, repeating it 5 times. But when it came time to get my surgery, my blood pressure was high because I didn't take my blood pressure meds. They were all mad at me for not taking my meds. I pointed out that they made it absolutely 100% clear that I was absolutely not to eat or drink anything, not even water, so I didn't take my medicine. They all acted as if I was stupid for following their instructions to the letter and told me, "well, you can drink a little water to take your medication". They should have told me that before. How do you think I felt? I fasted for nothing. I was the one who was hungry, thirsty and had to reschedule and fast all over again.
They should have given you better instructions it wasn't your fault
Good for you for following their instructions. I hope you got compensated for their incompetence.
Yea some medications still need to be taken before surgery (which the medical team will tell you) and it’s common practice to let patients know they can have a small sip of water to take these.
That’s not your fault. In fact you’re one of the good patients who followed instructions to the letter. Most patients ignore half of their instructions.
Just swallow
i would of forsure told them about it but they should of asked u if u haf any medication or anything
I remember hearing a story about a dad who had to bring his young daughter in for surgery, he felt that the "no eating or drinking" rule was too strict so he let her have breakfast, she later died of pulmonary aspiration during surgery and that has scared me into listening to my doctor very closely
Because doctors never stress the importance enough. Most just say "don't do it". More would pay attention if they were told it would kill them.
Ye he should be in jail
@13. Ghani Ziyad Sagiansyah Ah but if the doctor tells them there is a high chance of dying if they eat or drink, and then the patient does so anyway, now it's on the stupid patient who thought they knew better than the doctor.
@@Skenjin yea, I wonder why they don't explain it.
@@xponen patients lie
Reminds me of the story of a lady checking in at surgery with her 10 year old son. Nurse asks if he has eaten anything in the last 8-10 hours. She says no, while the kid is eating a bag of Doritos. She gets mad when the surgeon cancels surgery.
🤣
Typical “Karen mom”. 🙄. There’s getting to be so many of them it’s nearly a damn epidemic.
@MAGAdestroyer No, people are actually that stupid.
As somebody who spent nearly six weeks in the hospital with aspiration pneumonia and a related lung abscess after I aspirated my stomach contents during knee surgery, I can attest that this is a serious and pressing concern.
Should've listened!
@@Rust_Rust_Rust Depending on where he is from, it might be a communication problem.
Here in germany, I was once scheduled to get some blood drawn at about 6:00 in the morning, the doctor told me to come in "Nüchtern", which translates to sober. I told him no problem.
Next morning, I come in and get asked if I am sober - which I was.
Later on, I get a call regarding the results, asking me if I really was sober. I told them yes, I haven't touched alcohol in a few months. They said that in this case, the sobriety required was from food - which I didn't know, since it was the first time I heard "nüchtern" in regards to food.
That wasn't too big of an issue, since I could just get my blood drawn again, but if I was scheduled for surgery and didn't know this, and the medical staff doesn't explain what exactly they meant by that sobriety, I might see how someone can come in after having some food, and still feeling like they listened.
@@RevCode I thought germans had a word for everything
@@VMUDream You could actually make a word up for this, which would be valid - Frühstückslos, for example, which would mean without breakfast. Or what would be more common, but it would be 3 words: With (an) empty stomach, "Mit leerem Magen".
how long did you eat before surgery? probably should edit your post before you freak ppl like me out.
"She was fussing because she was thirsty, so I gave her a little juice. I didn't think it was a big deal
" the dad said to the surgeon, after his daughter almost died from aspirating fluid into her lungs while under anesthetic.
doctor didn't explain why people need to fast.
@@xponen acid on a non functioning body is dangerous
@@xponen you underestimate how dumb some people can be
@@xponenI can be fine without getting food, but without water, I can't. I feel dehydrated quickly.
You mean *mom. Fathers are smarter than mothers.
In outpatient surgery, we have many patients lie about not eating or drinking. Then we find out when we extubate , they aspirate , then we have to call an ambulance to transfer them to the hospital on a ventilator. Or they lie, and feel the pressure right before surgery and say, well, I did eat a jelly bean….but usually it’s much more than they admit to. I really wish the pre op instructions would tell patients this is actually a matter of life or death that they don’t eat and drink. I think they just tell them to not eat or drink but never say why
I don’t see why they don’t say life or death
@@michaellemmen me neither. People are more likely to listen and it’s actually the truth
Can confirm they don't say why, I'm watching this video because I've always wondered why. I legit thought it was because a) it would affect the anaesthetics effectiveness, and b) because they didn't want to get vomited on 😂
@@Phoenixhunter157 at work my supervisor got angry when I said you may feel pain after getting a MRI arthrogram. She said you’re not allowed to say that or patients may back out and get scared 🙄 so I have to use the words discomfort and soreness
That's an excellent point. Doctors should be required to explain that it's a matter of life or death. I had no idea of the reason either.
I was wondering how anesthesia was handled with emergencies, such as appendectomies, where the patient hasn’t had time to fast before the surgery. Thanks for posting.
He didn’t really go into it much but RSI requires an OG (orogastric or mouth stomach) or NG (nasogastric or nose stomach) tube which sucks the stomach contents out of your stomach to reduce the incidence of aspiration. This isn’t fool proof which is why it is preferable to have someone fasted before anesthesia. I’m an oral maxillofacial surgeon and regularly we use the OG or NG tube after anesthesia because blood in the mouth can be swallowed and come back up which can have infectious bacteria in it due to being in the stomach during surgery involving the mouth.
@@drjjohnson44 Thank you! I was always curious what the answer to this question was.
They put a tube through your nose that goes into your stomach. It was not fun.
no such thing as an emergency surgery. surgery is a lie. i would know i cant get it even though going without it is killing me. fuck this country so badly. also im so jealous of people that can get it. genocide in the usa.
@@drjjohnson44 This would be preceded, during RSI, with Sellick's Manoeuvre / cricoid pressure. The airway must be secured prior to inserting an NG tube. Alternatively, the NG tube may be passed with the patient awake and upright but this is a most unpleasant procedure and not always possible as time is of the essence with appendectomies, etc.
Trying to explain this to my cats before they have a dental cleaning under anesthesia is always an issue. We have to go around the house the night before and make sure that all the water bowls are taken up and all the toilets are closed. It's especially a point of argument if only one is going under anesthesia and the other has to whine and go hungry all day.
Water is usually okay to leave out, but food after midnight is a no-go. Even if the pet is fed, the premedications usually cause vomiting, so that takes care of the issue.
vet tech here water is okay till morning of, when you wake pick up bowls also so happy your getting dentals for your cats here in texas thats uncommon
My doggie has the same problem as your cats. 😃😃
a cage will help with managing pre- & post-operation of pets because it forces them to take a rest rather than let them roam around and play.
@@Fluteperson01 In spite of that, the poor boo boo had to get his lower fang removed.
I have type1 diabetes and recently had a short surgery under general anaesthesia. While I was waiting before surgery my blood glucose was falling gradually and eventually I could see I was going to have to do something about it. Normally I'd just eat something but obviously that was out. I let the nurses know about the situation, thinking it was all going to be pretty simple, since to me this is a completely normal kind of situation and I knew exactly what needed to be done.
But I forgot that's not how things work in a hospital. Any time someone has Type 1 diabetes everyone seems to completely panic because it's just something they only have to deal with rarely. I know they just needed to give me some IV glucose but the nurses have to go and find a doctor to make the decisions. The doctor turns up, starts asking me questions about what symptoms I'm experiencing due to low blood glucose, I have no idea why! She decided they were going to start sliding scale treatment (IV glucose _and_ insulin) which is used when a patient can't manage their own diabetes for whatever reason. This was about a 2 hour surgery so definitely not required in this case.
Anyway, the hospital had just got a new computer system so the nurses were trying to work out how to log the medications on the system, and whether to start the insulin or glucose first. When I heard that, I couldn't quite believe it! At this point I've been hypoglycaemic for an hour, getting worse and worse, and now I'm hearing they're going to start giving me insulin?!
I'm normally a pretty chill person, but if you've ever experienced being "hangry" you can probably understand my getting a bit more assertive sitting there with a blood glucose of 2.5 (45 in american units)
Doctor was long gone by that point so I just told them to start the glucose now and we can talk about the insulin when I'm not about to expire, which they did. Half an hour later I'm feeling much better, apologised for being short with them, and with my brain working again I was able to explain that I didn't need any insulin and the problem was sorted now.
But what a rigmarole! honestly if they hadn't been watching me the whole time I think I would have just eaten 20g glucose and sipped a mouthful of water. I think really that would have been the best option too. The glucose would have been completely absorbed, leaving nothing in the stomach. But I appreciate there are procedures that are designed to cover the majority of situations and be simple enough not to leave open the possibility of confusion.
Having Type 1 in a hospital situation is a nightmare because you're used to dealing with this complex condition all by yourself, and become an expert. But then you go into a hospital and suddenly somebody else is in charge of it all, and they don't actually know what they're doing.
If you have type 1 and you're going into hospital for any amount of time, I recommend insisting on seeing the diabetes specialist so you can have a conversation with them, work out how the condition is going to be managed, and then they can advocate for you with the medical staff.
Can you heal from type I DB or
@@paulenriquez8307 No
I provide my surgical doctors a simple list of requirements. On the list: Since I am able to keep my BG below 10mmol/L or 180mg/dL, they can too. ( I awoke from a 7 hour cholesteatoma removal surgery with SEVERE thirst and vomiting (and pain). Demanding fluids, then vomiting, rinse and repeat. Why? Because my BG was 40+ (too high for my glucometer but not the lab). Absolute incompetence. I will never let that happen again...the pain from the head surgery combined with vomiting. I felt like I was going to pass out each time.
Also on the list: - saline IV only (or LR, if absolutely required). No glucose in the general IV bag. They can add a bolus of dextrose when and if it's needed. Once I am awake and functioning I will take over ALL insulin administration.
There is only about 6 or 7 things on the list and none of them are really all that demanding.
I have only self admitted to the ER once because of hyperglycemia (pump failed without me noticing for 12 hours....I was happily drunk and then sleeping soundly, LOL). Because of the new symptoms, I went to the ER. They were treating my severe hyperglycemia with regular insulin and glucose in the IV. I was upset. Very upset. I called my Diabetes doc (internist) and he unofficially recommended I leave "against medical advice" and treat at home. So I did.
The hospital can be a very unsafe environment for an insulin-dependent diabetic. Training needs to improve. Too many horror stories.
@@paulenriquez8307type 1 diabetes is an autoimmune disorder where the pancreas is attacked by the immune system preventing insulin release. They have to use artificial insulin for life once the diabetes is present. They must also monitor their blood glucose levels in order to ensure hypoglycemia or hyperglycemia do not happen as either can become fatal. Type 2 is sometimes curable through diet and exercise, as it is caused by insulin resistance instead of a lack of production.
@@KatieTheDev so it's like lactose intolerance but for sugar?
A friend of my dad's has a story related to this. He was set to do surgery on a little girl, about 7 or 8, and instructed her parents not to let her eat anything from the night before the procedure. While on the operating table, she started vomiting, and went into cardiac arrest.
It turned out that, since the little girl had been complaining that she was hungry, her parents had decided some eggs for breakfast would surely be fine... right?
In the end, they managed to bring the girl back, but that story has always stuck with me.
It didn't happen to your dad's friend, you read it online lol. Such a fucking weird thing to lie about to feel special. Might as well have just said it was your friend, would have made no difference.
I expect that.
Thanks for the information. I'll start taking those no food or drink orders more seriously from now on. I've had quite a number of surgeries for a number of different medical issues. Usually I do refrain from eating well in advance, but I do occasionally sip some water before surgery. I always thought that no food or drink order was to prevent nausea. Never realized it was all about aspiration.
I always have my morning coffee even if I'm told to fast. I've never had a problem.
@@rachelmartin3631 you will have a problem soon, you cool republican weirdo
@@rachelmartin3631i hope now you understand why you shouldnt
@@Das644 there's nothing wrong with water tea or coffee, it absorbs in as fast as 10 minutes
It may not prevent nausea (I had terrible dry heaves with mucus after my surgery, side effect of anesthesia drugs) but it probably helps a whole lot with not having to clean up a huge mess afterwards.
I think it's odd that people don't listen when they're told not to eat or drink anything before surgery. Why wouldn't you listen? They tell you that for a reason, even if you don't understand why.
How about the ones who are supposed to quit smoking before surgery, and don't? People have lost fingers, etc. due to poor circulation caused by smoking.
@@B.H.56 Now I need a cigarette.
Don’t forget cancers oof
Primal instincts
Seriously, if you don't understand why, then just fucking ask them, duh.
I had an emergency appendectomy when I was 18, in 1980. A couple of hours before my symptoms became bad enough that we headed to the hospital, my mom got me to try eating a light lunch to see if it helped. The first thing I heard when I woke up in recovery was two orderlies speculating about whether it was half-digested chicken soup or chicken salad they had just cleaned up. I signaled my return to consciousness by croaking "Soup". 🙂
😂😂😂😂😂❤❤❤❤❤❤❤❤❤
Soup
We had a patient come in for a tilt table test. I asked her when she ate last. Answer was, about two hours ago. What and how much did you eat? A plate of liver and onions with mashed potatoes and a coke. She got rescheduled! I had a chat with her about why it’s important to not eat prior to this test. There is a risk of aspiration should a patient lose consciousness.
I have been in other situations where the patient says they’ve not ate but during a procedure the truth comes up….literally!
All we have to go on is what the patient says.
I've had issues vomiting during procedures even when not eating for 12 hours prior, due to severe issues with my LES and severe GERD, usually vomit up stomach acid/bile/liquid.
What about local anesthesia? Is it still forbidden to eat or drink?
@@eurekadiaz3771 what a fucking stupid question.
My granddaughter has the same issues as doing as the anesthesia is administered she vomits her stomach acids. It's scary!
WHAT lol I got a tilt table test and I was allowed to eat and drink 😆 Everyone I know who got one did so BECAUSE they frequently pass out, we're not walking around on an empty stomach all day 🤣 Dysautonomia fainting spells last like 3 seconds I'm usually awake the second I hit the ground
My father had a quadruple bypass in 1990. He died from pna from aspirated stomach acid. Back then they didn’t have the cuff on the endotracheal tube, so it just flowed up. Ironically, his heart was fabulous, sepsis killed him😢
Rest in peace, father of Mary Hedlund.
I’m so sorry!
That's really sad. 😢
He died from something called pna or sepsis?
I’m glad I followed the instructions well! I had my surgery at 12:30 in the afternoon, didn’t have anything to eat since 6 o’clock the night before, even very little or no water after midnight. All I really had the night before were a couple of cups of kava stress relief tea, and a melatonin. No caffeine since early morning, and certainly no alcohol in three days.
I've had a number of procedures where I had only been allowed a sip of water the day of surgery in order to take medication. It isn't as bad as it sounds and much better than having serious issues as a result of eating a 4-course meal before an 8-hour surgery
My surgeon used to not eat or drink anything when he had to do longer (6+ hours) surgeries like mine
i had 2 major brain op's and they told me not to fast and all that stuff never gave me a real reason as to why, THANK YOU so much for doing this
I know that when you're going to surgery, you're forbidden to eat or drink anything, but i never know that it can life threatening. Thank you for your video.
When i was going for surgery to remove a metal pin on my broken arm, my surgery starts at 4pm, i was fasting from 8/9am i think, and on 3pm i'm feeling really thirsty that makes me really want to drink a mineral water, my thoughts at that moment was "it won't matter too much right? because it's just a regular water", but then for some miracle i didn't take it and endure the thirsty feeling. Thank God my surgery was successful.
I had a really fun experience with anesthesia last month. I have a multitude of sleep disorders which always get the anesthesiologist’s interest. Anyway, I remember being taken to the OR, being given two syringes of stuff and being asked “are you getting tired yet?” I said no. Then we talked about Whitney Houston who was playing in the PR and how no one in the room seemed like the Whitney Houston type. Then another anesthesiologist showed up, told the original anesthesiologist to skip to the fourth syringe while he drew up some other stuff. Finally I was out. I was quite the topic of discussion in the PACU. Fun times. 🤘🏻
Great video. I've always gone extra time, for fasting, and I fast 2 days prior to surgery. That's 2 days prior, and day before, with only broth, jello, water until 10 hrs prior to surgery. Then only water on evening before, stopping water 8-10 hrs prior. Anesthesiologist and surgeons are always thrilled when I tell them I did this in the pre-op. Limits post surgery nausea, too. Some people, it takes a long time to completely digest. Some can't do this if they're diabetic. Otherwise, I swear by my fasting technique. Jello is good.
As someone who type 1 diabetes I was allowed to drink a small sugar drink 30 minutes before I had a big heart surgery it was more important to prevent a low blood sugar. As having a low blood glucose under general anaesthesia is more dangerous
When you have a scheduled planned surgery, you always have to get cleared for surgery by your physician and they do bloodwork and make sure that you’re healthy.. i had a tympanoplasty and had to have all the tests done before the week of
I appreciate that you’re upfront about what you sometimes eat when on-call. Some medical YTers have you believe they’re Olympians of nutrition
I enjoy your videos and anesthesiologists play an import role to the patient’s mood going into surgery. I’ve had 15 surgeries, 14 I remember. There were two with the same doc and the second surgery when I got to the operating room it was the same anesthesiologist. He was so nice and fun the first time, and this was so much more serious, complete bowel obstruction with sepsis, I was so glad to see him. You seem like a fun one to start off in the operating room with.
Thankyou for explaining! I am still baffled at people who don't take this seriously or feed their children before surgery. Like, we get it, its difficult to go hungry for 8 hours, especially for a cranky child who doesn't understand, but its only temporary and they will not die. When I was a teen, I was in the childrens surgery unit for day surgery and I was in a small cubicle waiting for anesthesiologist, another family was next door with parents and a 4 year old boy, the doctor asked them clearly, "has your son had anything to eat or drink in last 8 hours?", the father replies, "no, but 2 hours ago he had some toast and scrambled eggs"... the doctor went silent, um... genius man, scrambled eggs and toast is FOOD! In what world is toast and scrambled eggs not food?? The doctors cancelled their surgery, rightfully. It seems like many parents are okay with the serious risks than to hear their whiny brats cry and complain... anything to shut them up I guess.
I dropped my daughter off for oral surgery a few months ago and at the checkin was a man telling the nurse “by the way, I had a coffee this morning. I simply can’t function if I don’t have my coffee”. She told him he definitely wouldn’t function after the surgery if they went forward. Obviously the surgery was cancelled and he could not understand why. He just wasn’t understanding how serious it was.
Some hospitals let you drink until 2h, some 1h and some 1 minute before surgery. Really a debate apparently.
For emergency surgeries, why can't an NG or OG tube be placed to remove the stomach contents? Seems like a logical way to avoid aspiration risk
I had jaw and genioplastic surgery as well as forehead reconstruction a year ago and being already underweight I think the lack of food prior and difficulty eating post surgery has definitely made the side effects and drowsiness of anaesthetics a lot worse
Reaction per amount of body weight is on a bell curve. so 10% of the population like me need truck loads to be put under, and 10% can need as little as 50% of the normal dose. If you need another operation I suggest eating loads of low GI carbs the day before, plus some quality protein and a large male will need about 6oz (160g) of actual protein over the day which is different for each source. EG meats have more in (per oz) than most vegetables. If you are a veggie, then a veggie chilli pasta works though pasta is not ideal GI wise. Raw carrot can be excellent for that as can most types of cooked beans.
Good info as always Max, thanks.
By coincidence, yesterday, I received my new bilateral ureter stents - the sixth set of them in 2 .5 years. Anyway, it's a relatively short (about 40 minute) simple procedure under general anesthesia with no incision required because it's done through the urethra. I followed all pre surg guidance: nothing to eat or drink after midnight except to drink 12 oz water 2 hours b4 arrival at hospital at 5AM. Procedure began at 8AM sharp with me "counting by 13's" just for fun. I made it to the 12 iteration (156) before succumbing to the anesthesia. There were no issues were the procedure and I was discharged at 9:45 AM.
Not sure how or why this video was recommended by TH-cam but I enjoyed it. It's informative and it's something I never thought I'd want to know until now.
This is very helpful. Wish that explanations were routine.
I have a congenital dry throat and so not drinking is basically impossible. Have found that using a hiking trick (sucking on a small rock) makes it possible for me to not drink before surgery. The look on the face of the person asking if I have anything in my mouth (they're thinking dentures etc) ranges from baffled to "no, I didn't hear that" when I say that I'm suckling on a rock. By the way, this is a common thing to do in a desert climate but I now live in the east,
Finaly, someone explained it! Thanks, Dr. Feinstein!
The funny/sad thing is healthcare workers can explain exactly why ignoring directions can lead to death but people will still ignore them thinking they’re the exception.
Acid alone can do it so its not fail safe
@@supme7558Your point is?
No, they deserved it. If you don't listen to a doctor's instructions for what to do and you die, that is your fault. You should have listened to the doctor.
No one deserves to die because of it!!!! But they should certainly listen so they do not!! Your comment was pretty callous u think a child under the parents control also deserves death?
For an emergency surgery, would it maybe be beneficial to pump the pt's stomach to clear out anything that might be in there, reducing the risk of aspiration?
We place a gastric tube in certain types of RSI cases to empty the stomach, but this comes with its own risks
Truly a side note on this is gastric emptying. I had a gastric emptying study done several years back and the radiologist (with decades of experience) stated that she had never seen someone empty so fast. Every ounce of what I injested was completely clear of my stomach within an hour. As a physician I know it will not be TMI to you but to others I must warn... It is the reason that I have a BM within 30 minutes of eating any true meal (most times within 15 minutes). My wife had gastric bypass and was warned about (and if she eats the wrong thing she gets) "dumping syndrome." I naturally have "dumping syndrome" and have so all my life. So myself could go under within an hour of eating a full meal and not stand a chance of suffering any bad outcome. A normal person could wait a few hours, and on the other end someone that has delayed gastric emptying could have to wait 6, 8, or even more hours. So I agree, and the standard of care, is to err on the side of caution, and to say 8 hours fasting.
I guess I'm on the other end of the scale. I was going in for a gastroscopy, and was told to fast for 8 hours. I did listen to the instruction, and didn't eat anything after going to bed the night before.
After the procedure the doctor asked me how long it had been since my last meal, since they had found food still in my stomach. I told him the truth: 15 hours. I walked out of there with a gastroparesis diagnosis (which I already suspected)
This video showed me I should really inform my doctors about that if I ever need a surgery. I clearly must fast more than 8 hours.
@@bflyw74 I have gastroparesis too :/
No.way
@@bflyw74that's how I was diagnosed with gastroparesis, too. Had an upper endoscopy to figure out why I felt so awful, and there sat my dinner from 14 hours previous.
I'm from the UK and I've had surgery a few times, I never quesioned why I couldn't eat before surgery I just always trusted that the doctors knew best and followed any instruction.
Great video man! Great info! I learned a lot!! That was amazing and awesome! I have had 14 surgeries because of my cerebral palsy! I don’t eat because surgery! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy! I really wanted to be a anesthesiologist!! You rock man! I like your shoes
Is there a cure for Cerebral plausy
@@paulenriquez8307 not yet, hopefully one day
I love your positivity. I’ve had 4 lung surgeries myself and I have really learned that staying optimistic, and sometimes stoic, is the only way to be able to go through it all. Keep it up ❤️
@@dewackste wow that ‘s a lot and thanks
I've become accustomed to surgeries done under local anesthesia. There's definitely some advantages. I've even asked for water and stuff and they accomodate to make me feel more comfortable.
Oh Patrick … how do you get through it
I’m a King too btw 😊
I'm like that too. And for dental procedures I usually ask if they can skip or minimize the local anesthesia as well.
The next surgery I'm scheduled for they seemed very reluctant to do with local only anesthesia. It's just removing a fatty cyst from the back of my neck. I understand that they are afraid of my moving around during the procedure and that it's a rare thing for the patient to be able to tolerate being cut while fully conscious.
The easiest answer is due to the anesthesia if you ate or drink anything, there's a high risk of you puking but because you're effectively placed in a deep sleep, it suppresses your gag reflex along with the numbness. So you would suffocate on your own vomit to death.
Anesthesia is not the same as a deep sleep. Case in point, people don't typically vomit when in a deep sleep.
@@MaxFeinsteinMD exactly. If you have to barf, your body gradually brings you to wakefulness so that you feel the nausea and know youll barf. At least that’s been my experience when I’ve had stomach virus (which always seems to occur in the wee morning hours for me. lol)
*Thank you so much for this video!!!* I'm glad I saw it. I have a habit of listening very closely to my doctor and doing whatever she (or he) says. When they say Fast, I FAST! They say nothing after midnight, so I have nothing after 6pm to make sure I'm empty. It's wonderful to see this video and realize my OCD has been contributing to my making it through surgeries. 🤗🥰
can you do a video about anesthesia vs a medically induced coma? How do you put someone thats in a medically induced coma under general anesthesia for surgery?
I remember as a kid in the 90's being allowed a clear breakfast before surgery. Usually Jell-o and apple juice. I'm curious if this is still a common practice for pediatrics, and if so, why are the standards different?
Even as adults now clear fluids are allowed I was able to drink juice up until 9:30 - 10:00am and I was scheduled for surgery at 1:30pm
I knew you weren't supposed to eat before surgery but I didn't realize this was the reason why. That's so interesting
This was a really informative video. One thing I've always wondered is why a King tube is never used by default as it does a decent job preventing gastric inflation and aspiration while still maintaining a patent airway.
I JUST HAD SURGERY LAST SAT AND WOKE UP during it with general anesthesia. I was facedown and no one could tell I was awake. I’d like to see your opinion on this. I had paralytic agents on board so I was unable to move although I was trying SO hard!
That's horrible!! I will be having surgery soon and I fear this so bad.
I'm surprised they couldn't tell by things like your heart rate! There are other ways to tell, from what I understand. I'm sorry this happened to you and I wish you all peace moving forward from may have been a very traumatic experience.
@@Kait2478 it felt like a very long time but I’m sure it was prob 10-15 seconds. I felt like I was choking and gasping for air (I know vent was on but I was panicking!!!).
GREAT observation though about the Hr. Never even thought about that! Idk what the heck happened. I know when I next woke up in PACU- I was pissed as hell and expressed it and the anesthesiologist actually said ‘it was near the end ‘. Bedside manner was garbage!! Unfortunately, we don’t get to pick anesthesiologist when having emergency surgery, or really any surgery for that matter!
@@GhostPepperMeg There was a Grey's Anatomy episode where this exact thing happened. In that episode they were also reluctant to simply apologize for the experience. I'm sure it would have gone a long way towards giving you healing and closure for you, too.
It would be interesting for an anesthesiologist to weigh in on your experience here.
@@Kait2478 yes def. His lack of care and compassion made it 100xs worse!!!! Ty
As one who has neen NPO midnight !ore times than I like to think about, I want to thank you for this video. Now it all makes sense. You da man, Doc!
I really appreciated this video. Everything you spoke of made sense to me. Maybe because I have a lot of issues with choking currently (neuro and eds related so waiting to try and sort it) and also waking with choking thanks to mucous from mast cell reactions. It’s not all the same BUT has a similar issue and then having gastroparesis, very experienced in trying to keep stuff out of my lungs! Thanks for explaining so clearly and showing us with drawings etc. I also appreciate that you speak about what is done now especially considering prior literature but what current literature says and so why it might (and probably should) change in regards to RSI’s. I’ve always followed the rules and now I’m definitely glad I did! Thanks 😊
I've seen people claim that the reason people aren't allowed to eat or drink during labor is in case they need an emergency C-section with general anesthesia. But most C-sections aren't done under general anesthesia, so some people claim that the rule is outdated and that it's worse for people to not be allowed to eat or drink at all when labor is such a strenuous event. As long as they know the risks.
Hi Will, you are right that food/drinks are restricted due to the possibility of an emergency C-section with general anesthesia. You are also right that *most* C-sections aren't done under general anesthesia. However *some* are, and those tend to be true emergencies which could be made potentially fatal if a patient has eaten.
Great to see the "X hours before surgery" advice and the "more hours for food than for water" advice. In the bad old days they would tell you no food or drink after midnight the day before. whether you were going under at 8AM or 6 PM.
I had cancer surgery 3 years ago and it was nothing allowed after 10pm! Then at 6 am they made me take a Benadryl by mouth with just a sip of water to reduce allergy possibilities. It felt stuck in my throat so the kind anesthesiologist told the nurse to give me a little more water. As they knocked me out my thought was 1) I changed my mind about surgery and 2) hope I don't aspirate. Then I blacked out.
Thank you for making this video, I definitely need to show this to my dad before he gets his surgery
I had two surgeries under general anesthesia in 2021 at a large health system hospital. The pre-op instructions stated no food the day of surgery, but I was allowed to have a few clear liquids the morning of surgery. I don’t recall the entire list but I do remember being allowed to have water and sprite.
Yeah the same for me
Very interesting, in both of my two surgeries, there was no water after midnight. No food 12 hours before surgery
@@ashewastakenTT after midnight for liquid is outdated and causes more harm as patients are dehydrated, more irritable etc. And actually when you give a normal stomach liquid, it causes it to empty faster so that's why they say within 2 hours. For some pediatric centers they say 1 hour is also fine for liquids
@@No-xh2csUMC Utrecht lets you drink until you go in. They say it is no problem and not any less safe. One of the best hospitals in The Netherlands so I believe them
Marsman, M., Kappen, T.H., Vernooij, L.M., van der Hout, E.C., van Waes, J.A. and van Klei, W.A., 2023. Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety. JAMA surgery, 158(3), pp.254-263.
I’ve got gastroparesis and im jej fed. I’ve had aspiration pneumonia (I have GORD too and i refluxed in my sleep one night, had my cat not gotten into my parents room my mum wouldn’t have heard my strange breathing and I’d probably be dead) and it had me in the ICU for a week. It’s both terrible and I felt absolutely awful. Also get hypos. So I just let the admission nurse know and they can have glucagon on hand. It really isn’t worth the risk!
What type of diabetes are you
Anesthesia scares me ever since my last time under. I have an issue with my right hand and last time I went under I had alot of dental work and when I woke up my hand was super purple and I couldn't move it otherwise I was fine. I will never forget to tell them about that if I ever need it again. Still freaks me out like two years later. I believe I have a collapsed vein in my hand that makes my thumb and pointer finger constantly a little swollen. Doctor said it was either a vein or lymph node issue but guessing how it reacted it's a vein issue.
I totally understand and accept that you should not eat or drink BUT only speaking about the UK NHS, they instruct all patients to follow the same rules as if they were first on the list.
I have had the unfortunate experience of not being taken down until very late, I was too anxious for food but thirst was a major discomfort. My son had an even worse experience, just falling off the list so he was removed and rescheduled, but because this was likely to be because an earlier patient had complications or for a medical emergency, it was necessary.
It would have been so much less stressful for updates on possible theatre time, and it would have been so much more humane for permission to be given for water to be allowed if surgery has to be delayed.
I do not know if other countries manage their lists and pre operative patients more humanely.
Just thank you for all of the time and effort you’ve put in these videos! I love all things health-related and particularly love how easily-digestible your content is.
My wife is currently in hospital (in the uk🇬🇧) due to an unrecorded hietes hernia that allowes aspiration during a lung and liver biopsy (key hole surgery)
As a result she was intubated for 23 days (so induced coma and paralysis) then had a tracheotomy for 2 weeks, currently a feed tube into the lower intestine and and a stomach drain (small tubes in/out of the nose.
Today she is scheduled for the hernial operation, and hopefully a final path to recovery.
Was admitted on march 27th and still in, was on icu for 30 days.
While she didnt eat before here key hole op, its a real life case study into what anesthetic and gas introduced in to the body for a routine procedure can do if there is a hidden weakness waiting for them.
OR nurse here. On more than one occasion, we found out a patient lied about their fasted state when they aspirated stomach contents on extubation (removing the endotracheal tube). They ended up in ICU. Play stupid games, win stupid prizes.
Thank you so much. I broke my ankle 6/2020. I waited inpatient for three days while inflammation decreased. Food and water was not held. I went into surgery. Woke up from orif surgery feeling good ( on pain meds). I went to sleep and woke up five days later in icu with severe icu psychosis. It was terrifying. I learned (after being told by several people “wow it is a miracle you made it” I aspirated. Developed pneumonia, sepsis, had heart and lung failure. I was on a ventilator for five days. They didn’t know if I would make it; as I had trouble coming off the ventilator. Max thank you. I understand better because of this video. I became terrified when I have to go under general anesthesia. (I’ve needed further ankle surgeries.) For the love of God, thank you. My ptsd is relieved. Now I know no food or water. Not even a tiny bit. 🫶🏼🫶🏼
I'm glad you're better now!
I've had aspiration pnemonia 4 times (not from anesthesia, but gasping for air while vomiting violently), and have permanent lung damage. I joke to people that "intelligent design" was made by an idiot... who puts the eating tube in the same place as the air tube of the body??
The hospital didn’t have you npo ( refrain from food and water) before your surgery?! That is negligent. Attempted murder. Dear god. I’ve never heard something so bad. I’m sorry
The anesthesiologist didn’t ask you when was the last time you ate/drank? If not, what backwater were you getting surgery…did you jump in Time Machine and travel to 14th century? Or did they ask you and you weren’t 100% truthful?
@@terrencecoccoli524she said very clearly she was inpatient and they didn’t withhold food - so why a comment like this?
@@garsh5453 I meant the part specifically about assuming the person was lying.. that was completely uncalled for.
I could watch a whole video on RSI in a variety of emergency situations. I'd love to hear you explain how intubation would proceed in a case of anaphylactic shock.
I have nothing to do with the medical field but I find your video’s extremely interesting, almost addicting!!🙃
Same here! I’m a carpenter and I found this channel after being put under for knee surgery and came out feeling like I was beat with a bat the following day. Had hand surgery and came out feeling great just wanted to know why I was hurting the first time and not the second. Maybe that’s why I’m a carpenter and not a doctor. 🤷🏼♂️🤷🏼♂️🤷🏼♂️🤣🤣🤣🤣
Seen multiple surgeries cancelled because the meal service guys miss the NBM sign by the bed, give the patient food, the patient thinks "well if I've been given it it must be ok" and hey presto, they're off the list for the day. Doesn't matter what they've been told by the anaesthetist, or the nurse. I think it's because patients abdicate responsibility when they are in hospital, they have limited understanding of the more complex stuff, so they allow every decision to be made for them, and if they get food, no matter what they are told, they assume somebody who knows more than them has made that decision to feed them and it must be ok.
I have gastroparesis and intestinal dysmotility. The last time I had a colonoscopy (with propofol anesthesia), I had to be intubated. This seems really unusual for this type of procedure. Even though I followed the directions for drinking the colonoscopy prep solution, a significant portion of it was retained in my stomach up to the time of the procedure, and there was concern for aspiration risk. It was really scary.
Sorry you had to go through that, colonoscopys suck as a person with ulcerative colitis. That stuff they make you drink is 🤢
Hello Dr. Feinstein - imo, this video is TRULY one of your best ones ever! The way you have explained why NOT to eat before surgery could very well save lives!! EXCELLENT video!! Should be used in classrooms in medical schools!
Can you comment on the prohibition of eating or drinking during labor? I read a Twitter thread recently by Mama Dr. Jones where an anesthesiologist was saying it was definitely necessary because of the possibility of general anesthesia later, but apparently the medical literature doesn't support fasting during labor, since it can extend the period of pushing and delay delivery, and the chances of undergoing general anesthesia for even a C-section are pretty slim. Seems like a huge oversight in the field that affects a lot of people if it's not actually beneficial in any way.
Definitely recommend fasting because there is no way to predict the chances of needing an emergency C-section ahead of time. In many cases patients that are completely healthy may need an emergency C-section. Even if they are not intubated, the medications given through a spinal or epidural for the C-Section can in many cases cause nausea and vomiting. Pregnancy already makes the risk of aspirating even higher than any other patient group. Having a higher degree of acid in those stomach contents can increase the risk of damage with vomiting.
Surely the chances of needing general anaesthesia for a regular delivery with no complications are low enough that this is way over the top?
I can understand this being policy if there are issues that make this more likely, but it seems like an unnecessary cruelty to me!
I can see why an anaesthetist might have this opinion, since they deal with "medical procedures" so to them, giving birth classes as a "medical procedure". I don't think most births count as medical procedures.
@@jhonbus The problem is that there is no way to predict what complications may arise. Perfect healthy patients can suddenly need an emergency section at any point. Imagine cases when the umbilical cord wraps around the baby's neck, or the shoulder getting stuck in the canal, or even just plain old no changes in the cervix. When comparing the risk of aspiration vs. the struggle of not eating or drinking for hours, it's a matter of risk vs. benefit.
Doctors don't just stop you from eating/drinking out of cruelty. It's because that is what is safe. It's also not a matter of general anesthesia alone. A spinal in an uncomplicated c-section can cause nausea. An epidural is an anesthetic procedure that can cause nausea and vomiting even if it's for a normal vaginal delivery.
@@osamasayed4110 Mama Doctor Jones' new video (you can search it, I don't think TH-cam will let me post the link) was pretty clear there's very little data supporting the practice of fasting during labor. The UK and New Zealand do not practice this at all and their obstetrics outcomes are a lot better than the U.S.
@@osamasayed4110 but there are the nose or mouth things that suck the food out of your stomach if you need emergency surgery
I've had several operations, all in different countries (by some karma joke or something), but only before a broken ankle operation in Japan, I was pulled out of my room by an anesthesiologist, was explained everything I needed to know about being "put out", risks and all, asked if I had any concerns or conditions I wanted to report, and was finally asked to sign a paper that I understood what was going to happen to me (not a waiver).
It was really reasuring, because someone took the time to come and tell me all details I needed to know, answer questions, and make sure I understand and feel secure (unlike other experiences that far). From my previous operations, I was already aware of the fasting prosedure, but that lady even made sure she was crossing language barriers. Still not recommended experience ;)
The RSI part of the video raised a question for me, that may be beyond the scope of what you like to cover. How quickly do hospitals and doctors change established procedures due to new information from studies? One study probably isn't enough to change minds, but does it make doctors hesitant? I am assuming part of it would depend on the thoroughness of the study and the impact on care suggested by the study.
It depends on a couple of factors (and I´m sure I have missed some): the quality of the study (randomized, double blinded placebo-controlled multicenter study versus retrospective case analysis or worse), application to your patient population (if you have a study pertaining to children, but you only treat people above 60yrs), the impact a change has (for quality of patient care, but also financially and time needed to perform) as well as spread of information (publication in a well-read journal versus hidden in a paragraph in some obscure book) - and nowadays lso if there has been a prominent law case tied to this (maybe the fastest way to force a change).
E.g. Cricoid pressure ("Sellick´s maneuvre") is considered obsolete (difficult to perform correct, worse view and therefore prolonged time to secure airway, and actually further decreases esophageal sphincter tone thereby increasing aspiration risk) by most European anesthesists now, but at Max´ hospital it´s obviously still performed in RSI...
they always say doctors are sooo busy and have no time to do anything else other than working in the hospital.
but surprisingly Max has time to make videos.
I make these videos at night and on the weekend 🤷🏻♂️
@@MaxFeinsteinMD I get that, Dr Max.
But you know, sometime the media said: you guys (doctors) have no time, no time to take a lunch, no time to take showers and no weekend etc. Maybe just case-by-case basis.😅😅
But anyways, I am happy for you no matter what
I had oral surgery recently, and once I was awake and alert, I thought ‘I could eat’. I was given an Ensure, which was good enough to hold me over until I got home. But I was starving beforehand!
1:00 Thank you so much for saying this! Many medical youtubers tend to put emphasis on going to your doctor if you have any worries, or that it is always better to have your doctor diagnose you, but they miss stating that, at the end of the day, they cannot make a medical opinion because they are not seeing you!
It might be a small thing, and many people might think it's not that big of a deal, but just as there are people that would rather have some snake oils because they saw it on youtube or facebook, there's also people that look at medical channels when they have any concerns, watch them, and get to the conclusions about their conditions instead of going to their physician.
I clicked on this because I'm pregnant and planning a c-section, and I also have hyperemesis and I get severely nauseous if I wait too long to eat, basically if my stomach is empty at all. I can manage mornings now, but I dread going in for my surgery and I really hope they can schedule it for FIRST THING in the morning.
My first baby, I went into labor spontaneously, but my baby was breech. I was informed when I checked in that I would have to wait 8 hours from when I had breakfast, or until I couldn't hold off any longer (if the baby came before then, for instance). When I was checking in, they asked what time I had eaten my cereal, and I couldn't quite remember. The nurses at the station kept trying to wink wink nudge nudge me to say it was later than I was guessing, for my sake because they didn't want me to have to wait so long in labor, but it actually really bothers me now knowing the risks of why that protocol was in place. If I had needed general for some reason and got to go into surgery sooner than the 8 hours because of a lie, I would have been at higher risk, without having had that risk explained to me. I'm a huge proponent of giving people INFORMED consent, and I think someone with that level of medical knowledge should've known better than to advise me in that way, despite whether they thought it was in my best interest.
Fascinating information!! I’m an aircraft mechanic and sometimes wish I could’ve been a surgeon!
last time i went in for a surgery (ovary cyst) the surgery team was pretty chill with the fact i did need some water to get the pills i needed to take down my throat
A stomach with contents is an aspiration risk, it may get into the bronchioles and cause a blockage and atelectasis. An empty stomach rules out these.
That is why patients have an NPO (Nil per os/nothing by mouth) order at least 8 hours before surgery.
Don’t you just love the patients who deny eating until a little midazolam and then they would confess to having a couple of sausage biscuits just before getting to the hospital. Any personal opinion on the use of cric pressure?
Re: Anesthesiologists & THEIR positioning; bringing a couple of pillows for under their legs and some extra warm blankets along with the nicest, anatomically appropriate chair from the OR Director’s office … isn’t that in your OR’s SOPs??
I loved your video discussing music in the OR from awhile back.
Its ridiculous, maybe benzos help as one of the last minute barriers.
This is one of my favorite videos of yours yet, Max! It's super informative with the drawing (shoutout to Mitch!). When you started doing the ultrasound on yourself I was like, cool! Then you make this ghetto bed with a chair and put your feet up, I was giggling pretty good. I almost feel like 3-5 years from now you're going to start breaking the rooms down to teach us things if this keeps up! XD
I had an emergency caesarean section delivery. Before going under anaesthesia. I was given something to drink. Can you tell me what this might have been and why was it used? Thank you.
Most likely bicitra to reduce the likelihood of injury in the event of a pulmonary aspiration.
@@MaxFeinsteinMD Thank you so much for your reply. I've wondered about this for a long time. Great channel. Thank you.
When I had surgery in 2013 (hysterectomy), my surgery time was in the morning at 9 or 9:30 or so. I was allowed to eat and drink like normal until midnight and clear liquids overnight until I think 4am. I took that very seriously and even overnight I wasn’t drinking much even though I was allowed to. In the surgery prep I was given some prophylactic antibiotics along with an oxycodone and naproxen (standard procedure for that type of surgery to lessen the risk of infections and have a bit of help pain management wise when waking up) and used as little of the water as possible to swallow those tablets as I happen to be pretty proficient at taking tablets with little or nothing to drink. The anesthesia team kinda looked at me like I’m an alien because I needed so little water to take the medicines (we’re talking maybe about a tablespoon of water)
Just better to be safe than sorry…
Would pumping out the stomach contents be an option in an emergency surgery?
It explains so perfectly, literally answered all of npmy questions.
Thanks for explaining! I have surgery today to get my collarbone fixed, haven't had anything to eat in like 14 hours and still have another 9 before the surgery. I hate this feeling but I'm sure I'd hate dying over a bowl of oatmeal more lol
Last year I had a hernia repair under general anesthesia. Doctor gave me orders not to eat, 12 hours prior to surgery and not to take my type 2 diabetes medication. I get dehydrated easily and asked if I could drink a small amount of water and that was okay up to 4 hours before surgery and to urinate as frequently as I could while hooked up to IV an hour before surgery.
Surgeons orders are to be taken seriously.
This was VERY informative!! I was allowed to drink water and that was it. As always, Thanks Max.
I'm freestyling; let's just go for it....classic ! Thanks Max, really love....and learn from your videos. I'm a fan for sure now
If someone does have a full stomach, and the surgery cannot wait, does placing an OG or NG help lower the risk?
There are some cases where we do place an NG tube before surgery, yes. For example bowel obstruction.
So the primary risk of aspiration is during the period between when the patient is anaesthetised and when the cuff is inflated on the endotracheal tube? Is there no oesophageal equivalent of the cuff? And is any kind of gastric suction ever used in emergency situations?
Great topic. Here’s a question. Can any of the general anesthetics given cause hiccups post op? Was in for a ureteral stone laser ablation on Tuesday and hiccups started last night on return home. Hopefully these are self limited. Enjoy Sinai. Did a preceptorship with Jerry Way back in 2005. Great GI Doc.
Thank you for explaining. I've been in anesthesia many times (22 I think) and knew roughly why I couldn't eat, but this clears things up a lot, Thank you :D
Ive had numerous surgeries in my life and I had one Anesthesiologist came into my room and said me O.K. What did we have for Breakfast this morning very sarcastically I told him nothing becauseI knew I was having surgery. I guess he deals with a lot of people that don’t understand you shouldn’t eat before going under for surgery.
this video is truly so good. it’s everything
i've been under countless times, i have this information seared into my brain! so much so that when my cat needed a dental cleaning i made sure she fasted even though the vet hadn't told me to. she had a long wait once at the vet's office, so if i was wrong they could give her food and water if needed. when i got there they told me i didn't have to do that, which is still strange to me! ah well, it went smoothly either way.
I had surgery on my mouth and throat 4 days ago to repair a gap in my palate. I couldn’t eat anything after 2:30am but I had a drink before 6:30am because I couldn’t drink after that time. Surprisingly I was able to have small sips of juice before I went into surgery and I was ok even though I was given a medication which sedated me before I had the general anaesthetic which put me to sleep because 30 mins before I went to surgery I had the sedative and I was normal at first and after a few minutes I was spaced out and didn’t even wake up until I was in recovery.
One fun fact: In WW2 it was recommended to go into battle on empty stomach because if you get wounded it had higher percentage to survive.
it's not true at all because hours before the D day they received such a copious meal that when they were going through the enlish channel a lot of them instead of fighting were seasick, bringing up and that cost their lives and it was one of the greatest blunder
@@alexsheremett3097 Maybe that recommendation was given based on the results of that blunder.
You're more likely to be wounded if you're tired and less alert because you didn't eat enough food...
max, you should do a video with a GI doctor about the requirements of anesthesia for an endoscopy or colonoscopy
Interesting video. I never knew it was a life or death thing. As a patient with no medical expertise, I thought patients had to fast to prevent them from throwing up once the anesthesia kicked in.
That’s what i always thought
Thats what he said
What do you think stomach content going up stomach and into lungs thats vomiting into your lungs hello
I have a History of Hydrocephalus (fluid can't drain from my head) and I was in the hospital once for surgery, and the nurse told me to take my anti-epileptic medication before surgery. I wasn't able to keep anything down at that time because of the pressure in my brain but I took the medication like she said, but I ended up vomiting it up in Pre Op. I knew that would happen, but I just did as she said
Excellent. Absolutely informative! Thank you!
Idk if anyone will read this, but as a nurse in training for me the question now shifts to the ICU patients. They are intubated and all their reflexes are shut off (for some, depending on medical condition). Now they often get artificially fed still through the stomach. Why is it then, that the ICU makes it work for patients not to aspirate the whole time, while surgery needs to keep a very close look on it?
Patients who are sedated to the point of having no reflexes are intubated. Like the mnemonic GCS < 8, intubate.
When they give the order to not eat or drink for twelve hours, it would help a lot if they included this video. The Dr/nurses have never explained why. They just expect blind obedience. Thank you for the explanation! 👍👍👍
And why shouldn't they? These people don't go to med school for the funsies of it.
Do you think….. never mind you don’t.
My best friend did this. She had some problems with anesthesia. She didn’t eat but drank a bit of coffee ☕️ we think, a couple hours prior to and early AM surgical condition.
As soon as they intubated her she coded! 45 years old! (Aspirated while being put to sleep)
It absolutely scared the hell out of all of us.
She rescheduled the surgery and didn’t consumer anything this time. And everything went fine. Thank God!
Absolutely don’t do it!
Especially if you have acid reflux.
Lastly, if you are extra concerned. Don’t eat anything after 7 PM the night before your surgery.
I always think it is a good idea to HYDRATE a few days before, so your aren’t a little dehydrated before surgery day. So drinking plenty of fluids (water 💦) like 6- to 8 ounce cups or bottles a couple days before your scheduled surgery helps ensure your veins are full and standing up plump so they can easily access your veins for IV (for medication and other treatment). Be a good patient! Don’t risk your life or be dishonest to nurses or doctors. Be honest. If you mess up and forget when you eat something, just tell them so they can reschedule your surgery. Good luck.! 🍀