I had a 6 year old child who was fasted for all food and drinks for 6 hours for an elective procedure, except he had been chewing gum for 2 hours up until 15 minutes prior to his surgery. The nurses had told him and his parents that the anesthesiologist would cancel his surgery because of this.

I wasn't too fussed and proceeded, uneventfully. I can't imagine that chewing gum could generate enough saliva or even gastric fluids sufficient to cause a risk of aspiration. I did a quick literature check but found nothing.

Anyone care to enlighten me?

We had a woman referred to us by the antenatal clinic (!). This is a miracle in itself but not the point of the story.

This woman is 34 weeks pregnant, and with a high grade placenta previa. The Obs Gobs guys are doubtful that it will shift between now and 38 weeks when they plan to do an elective Cesarean Section.

The problem is that she has had Harrington rods inserted during her teens to correct a severe scoliosis. She has no X-rays from  that time, and refuses an X-Ray before the baby is born. Her scar extends down to the mid-lumbar area. She is otherwise well.

I would like to give this woman a regional anesthetic, either an epidural or preferably a spinal, but I am not sure what degree of anatomical disturbance she has had resulting from the Harrington rods. I am assuming an epidural would be pachty and possibly ineffective because of the scarring and/or deformation in this area. Assuming I can get a spinal in, would it be effective? or would there be too much tethering/scarring/streching of the dura and spinal canal to render it inefective?

I would appreciate whatever input into this problem.