Are we risk aware or risk averse?

What’s wrong?

Do you want me to deflate the pneumoperitoneum?

My surgeon stops what he’s doing and just looks at me expectantly. I hadn’t said anything to him, nor had I really clocked my own discomfort as something about my patient’s physiology didn’t quite fit with the usual Feng Sui pattern I was expecting.

“Is the patient nil-by-mouth”?

A few months ago, I anaesthetised a patient for a routine operation. He was nervous, as many of them are, and had made the decision to forego his evening meal the night before surgery, and drink nothing after 6pm the previous day in order to be “extra safe” for his anaesthetic. When he told me, I responded with an outward smile and an inward eye-roll, popped out and came back with a glass of apple juice for him to drink, and a gentle explanation of how prolonged fasting is actually bad for his recovery.

Aspiration under anaesthesia is extremely rare in Europe, but it’s difficult to get accurate figures. Incidence for elective cases is around 1:5000 to 1:10,000. According to a UK Royal College of Anaesthetists audit, obstetrics is even lower with only 12 cases between 2013-2016, equating to around 5 cases per million pregnancies.