Wednesday, April 20, 2011

Rules- made to be broken or good to follow?

Before I write my next full length post I wanted to take a second to share with you guys something I think is pretty important. So here's a  short post to tide you over.

Every patient that comes in for surgery gets a list of things that they need to do to prepare for their procedure. Depending on what the procedure is it might be to temporarily stop taking certain medications, they may need to bathe with a special soap, or do a bowel prep (drink some nasty tasting stuff so that they poop alot). But there is one preop rule that you can count on being there. If your procedure requires general anesthesia you will be require to be NPO (nothing by mouth) for at least eight (sometimes twelve) hours before your surgery.

NOTHING by mouth. Nothing. No food or drink (not even water), no chewing gum, you're not really even supposed to brush your teeth. Why? Because whenever you put things in your mouth that sends a signal to your brain that you need more gastric acid in your stomach to aid with digestion. That's a bad thing when you go under general anesthesia because there is a real risk that the breathing tube could trigger your gag reflex and cause you to aspirate (breathe in) the contents of your stomach. That's bad news folks.

We don't tell you can't eat or drink to be mean or to torture you. We tell you that to save your life. So it's important that you follow the rules and even more important that if you break them you come clean about it. Yeah, it's probably going to delay your surgery for a few hours and you still won't be able to eat but at least you'll be alive.

Yesterday I was working in pediatric dental surgery. The kids that come through are very young, a lot of times under six, and need to be under general anesthesia so that we can fix or pull their teeth. Because the patients are so young we have to rely on the parents to make sure that the rules are followed and we trust that they will be honest with us.

We had done three cases and was about to start our fifth when a preop nurse called into the room with some news. She had caught our next patient drinking out of the water fountain. Uh oh! So the doctor went to talk to the mom and tell her that we would have to postpone the surgery. The mom was outraged and said "Why is the water such a big deal? I mean, he had a bag of chips on the way here!"
Oh really? Well in that case the surgery is cancelled. And the mom just couldn't understand why we were being so strict and mean. I'm sure it must be hard to not feed your kids when they're hungry but eating before general anesthesia could kill them. We don't just tell you not to eat because it makes our job easier.

So please listen carefully to all the instructions your doctor gives you before surgery. And if you slip up, come clean before hand. It could save your life.

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