Awake intubation – A viable approach for preventing aspiration in patients undergoing emergency surgery after administration of oral contrast material

AbstractPulmonary aspiration of gastric contents during the perioperative period has significant morbidity and mortality. The aspiration may occur immediately before, during or after the actual act of endotracheal intubation. Fasting before elective surgery (nil per os [NPO] after midnight) is based on the historical presumption that the absence of intake of solids and fluids will minimize the gastric fluid volume at the time of induction of anaesthesia, thus decreasing the risk of pulmonary aspiration of the gastric contents. But this fasting is not possible in emergency surgery. The practice of routine administration of OCM for abdominal computed tomography (CT) for abdominal surgeries requiring general anaesthesia or in obtunded patients violates the nothing per os role that is crucial part of anaesthesia and can lead to aspiration causing morbidity and even mortality. Awake intubation may be a suitable alternative in such high risk cases for aspiration