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Ronald M. Meyer, MD
Columbus Hospital Northwestern University Medical School Chicago, Ill

JAMA. 1990;264(1):33-34.

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In Reply.—

I appreciate the opportunity to reply to the thoughtful comments by Dr Gevirtz. I tend to agree with him on all counts. To address them in reverse order, it certainly is worth reminding the surgical staff that patients may aspirate gastric contents during surgery, even without general anesthesia. For example, the patient could convulse or lose protective airway reflexes following an unintended intravenous injection of local anesthetic. At my hospital, the office of the physician scheduling surgery is, unfortunately, often the only place that anyone has an opportunity to warn hard-to-contact patients to fast preoperatively.

I take little comfort from defensive notes that I write in patients' charts. I believe that I have a duty to discuss the situation and the options with the patient to arrive at a feeling for what is in her or his best interests. For example, delaying anesthesia on the grounds of minimal . . . [Full Text PDF of this Article]

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