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Non-Fasted Emergency RSI Decision — FRCA Final MCQ

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EasyTrauma & Emergency AnaesthesiaNon-Fasted Emergency RSI DecisionFRCA Final

A 28-year-old man (ASA I) is undergoing emergency surgery for testicular torsion. He is extremely anxious and requests a general anaesthetic rather than a spinal. He had a general anaesthetic without problems 6 months ago. He has eaten a sandwich 2 hours ago. What fasting category does this place him in for general anaesthesia?

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Correct answer: A — Not fasted – requires RSI

This patient has eaten a solid meal 2 hours ago. The standard fasting guideline for solids is 6 hours (AAGBI 2022). He is therefore NOT adequately fasted for an elective induction. However, testicular torsion requires emergency surgery (within 6 hours of onset for testicular salvage). The correct approach is rapid sequence induction with cricoid pressure to protect against aspiration. The urgency of the surgical condition outweighs the risk of proceeding on a full stomach with appropriate airway precautions.

Reference: Association of Anaesthetists – 2022 – Fasting guidelines; RCOA – 2023 – Emergency anaesthesia module