chewing tobacco

[Gas you down]

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npo guidelines? a guy comes into preop chewing tobacco. hand i&d after fight with a wall. how long do you delay. I searched past posts and saw 4 hrs once. that seemed reasonable. couldn't find any real recommendations, though.
anyone else have different thoughts?

 

[pgg]

I would treat it like chewing gum, or clear liquids, 2 hours. Assuming he's not "gutting" it. (Eww.)

 

[kazuma]

I would treat it like chewing gum, or clear liquids, 2 hours. Assuming he's not "gutting" it. (Eww.)

"gutting" can apparently lead to significant GERD. A friend from college had severe GERD which he attributed to his high school days when he and his buddies would swallow it to avoid getting busted whilst chewing in class.

 

[deleted171991]

I would treat it like chewing gum, or clear liquids, 2 hours. Assuming he's not "gutting" it. (Eww.)

Hmm... Isn't that tobacco particulate (not like chewing gum)? If yes, 4 hours for me.

 

[norwood]

Hmm... Isn't that tobacco particulate (not like chewing gum)? If yes, 4 hours for me.

Yep. I always assume some of it went down the hatch, considering that after pts spit it out, there are all those bits of tobacco on their tongues.

 

[IlDestriero]

I'd call tobacco somewhere between a "clear" liquid and a light meal and say 4 hours. And I'd probably RSI them anyway. I can't imagine chewing tobacco particles in the lungs would go over well.

 

[pmichaelmd]

We have come across the same thing and, as a group, decided on 6 hrs. I have read some recent publications from Europe which suggested that 2 hours was enough, but we err on the side of caution, particularly in this medico-legal environment. We have suctioned some nasty "snuff" residue from folks' stomachs and we know that aspiration of it can cause pretty severe pneumonitis. So...particularly for elective cases, we draw the line at 6 hrs for now.

 

[loveumms]

I would do 2 hours (like with gum and some candy) - I personally think people lie to us ALL the time about NPO status. I usually err on the less conservative side as gastric emptying is usually pretty rapid.

 

[pmichaelmd]

Suppose it also depends upon your population. Our population, unfortunately, is largely diabetic and morbidly obese. Good times!

 

[Jay K]

Suppose it also depends upon your population. Our population, unfortunately, is largely diabetic and morbidly obese. Good times!

Your population meaning the United States? 😉