Case reports:

Case 1: “Patient was booked for left inguinal hernia repair +/- bowel resection in CEPOD. Post-op during removal of I-gel, the patient vomited and aspirated. The patient was intubated and an NG tube was placed.”

Case 2: “Patient attended theatre for debridement/drainage of haematoma on lower leg. Despite being appropriately fasted, patient aspirated large volume of gastric content around the time of LMA insertion. Managed with suction, intubation, airway toilet and initially stabilised. Shortly after transfer to theatre became more hypoxic, ICU consultant attended to assist. Bronchoscopy and further airway toilet performed, plus recruitment manoeuvres. Continued deterioration over the next 60 mins or so, with worsening hypoxia and cardiac failure, despite further bronchoscopy and inotropic drugs. Second ICU consultant attended theatre but consensus from ICU and anaesthetic consultants was that situation was futile. Patient died in theatre.”

Commentary:

Clinicians must assess the risks and benefits of using supraglottic airways in emergency cases.This was an emergency list and the operation included the possibility of bowel resection. Many anaesthetists would have chosen tracheal intubation from the outset. Nothing is mentioned about the seniority of the anaesthetist or level of supervision. Case 2 is a reminder that even in surgery for non-abdominal pathology, assumptions about adequacy of starvation in emergency patients may be falsely reassuring.