BJS Academy>Surgical news>The other side...
(1)
The other side of the barrier
Dr Helgi Johannsson
Consultant Anaesthesia; Imperial College Healthcare
24 July 2025
Other side of the barrier General
(1)
Related articles

Who said nil-by-mouth?
Dr Helgi Johannsson
“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.

A surgical life by Agneta Montgomery
My surgical life What made you decide to become a surgeon? Art and design have always been a passion in life. I designed and sewed almost all my own clothes when growing up. When my twin brother was to get married, he wanted to wear a white dress suit. I tailored it for him as there was nowhere, we could find one. I have kept on tailoring abdominal walls.

A surgical life by Takeshi Sano, MD, PhD
I am a surgeon specializing in gastric cancer. I graduated from the University of Tokyo in 1980, and after surgical training, spent 15 months at Institut Curie, Paris as a research fellow with a French Government scholarship. This flavoured my subsequent life with a European taste. For the past 30 years, I have concentrated on surgery and clinical trials on gastric cancer in the two largest cancer centres in Japan, the National Cancer Center and the Cancer Institute, traveling around the world for lectures and live demonstrations of gastrectomy. I have been also involved in formulating domestic and international classifications and guidelines for gastric cancer. Nowadays, I have almost left the operating room and am engaged in management as Hospital Director of the Cancer Institute. What made you decide to become a surgeon? I was born in to a medical family going back many generations in a small castle town and had no alternative but to become a doctor! During the clinical classes in medical school, I was bored with reading the thick medical records written by earnest residents of internal medicine: lots of data, differential diagnoses, copies of references, but no clear solution. Surgeons’ patient notes were fascinating: simple description of surgery with drawings, uneventful postoperative days, sometimes followed by unexpected pathological results. A senior surgical resident confessed that he was not a diligent medical student (too busy with his soccer club) but was able to stand on the same starting position as other brilliant classmates. The story was quite convincing.
Copied!