5. NPO Status
Let's talk about relative risk. Humans are very
poor at understanding relative risk. When you look at decisions
you should add up all the risks. If one risk is huge, the other
risks don't really matter because the common and frequent risks
will cause the problems.
Let's take NPO rules. Anesthesiologists are very
good at enforcing NPO rules. We ask every patient when they ate
last. If they ate in the last 6 to 8 hours, and the case is elective,
we delay or cancel until it has been 6-8 hours. Well, what is
the risk of death from aspiration pneumonia? 1:10,000 to 1:20,000.
If you take a pregnant woman, at term, in labor, and you feed
her a grand-slam breakfast at Denny's, and then you put her to
sleep mask anesthesia, the risk of death is 1:200. Now, your chairman
would probably call you aside and fire you for providing such
care, but the real risk of death is 1:200.
What is the risk of perioperative mortality in
a patient at risk who does not take their beta blocker? Well,
if they are like Polderman's patients 1:3 risk of death. If they
are like the average patient coming for major surgery 1:33. So
perioperative beta blockers and BBAC is between 6 and 300 times
more important than NPO status. Every time you ask if a patient
has had breakfast, you should ask if they got their beta blocker.
It is 300 times more important than NPO status.
