Retired surgeon hopes preoperative fasting rule is changed; dementia and sexuality

02/10/2014 12:00 AM

08/08/2014 10:21 AM

Eating and drinking before surgery

If you’ve ever had surgery requiring general anesthesia, chances are good that you were told not to eat or drink anything after midnight on the day before. This is to prevent the possible aspiration of stomach contents into the lungs while your normal protective reflexes, such as coughing, are impaired. Though the American Society of Anesthesiologists revised its guidelines in 2011, saying patients can have solid foods six hours and clear liquids two hours before surgery, many doctors still feel safer using the midnight rule, and debate continues.

The retired surgeon who writes the lively Skeptical Scalpel blog joins the fray with his own story of being forced to delay an operation for six hours by an anesthesiologist who said the patient had had a piece of hard candy. “Being a very reasonable guy, I went ballistic and demanded to see evidence that sucking on a piece of hard candy was problematic. … No such evidence was produced.”

In his usual curmudgeonly style, the Scalpel summarizes what’s been written on hard candy, gum and preoperative fasting in general, and concludes: “I’ve heard that it takes something like 10 to 20 years to change just about any [thing] we do in medicine. Let’s hope this one doesn’t take so long.”

Other recent posts on the blog – which defends its author’s anonymity with an Oscar Wilde quote saying that only a man in a mask will tell the truth – include how to handle non-English-speaking patients and whether surgeons need to adopt a dress code.

‘Sexuality and Dementia’

“There’s something that happens, something that scares me, and I don’t know what to do about it,” a woman identified as Kate tells Douglas Wornell, a geriatric neuropsychiatrist, in his new book, “Sexuality and Dementia.” Kate’s husband, who is in his 70s and suffering from dementia, has suddenly become sexually aggressive. “Is it normal? … Am I wrong to give in?”

In another case, a nurse describes finding one patient with dementia raping another – and how the subsequent gynecologic examination was as disturbing to the confused victim as the rape had been.

Uncharacteristic or inappropriate sexual behavior is a common aspect of dementia, writes Wornell, who says he has treated 20,000 patients with the condition. But it is often too shameful or embarrassing for caregivers to handle or even to ask about. In sympathetic and easy-to-understand style, he offers personal stories of how some of his patients have handled the problem, plus information on the contributing role of medication, ways for spouses or other caregivers to respond to unwanted behavior, and some of the legal issues involved.

Washington Post

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