It was a curious case, probably the first in the world literature.
She was a young woman, scheduled to undergo a transobturator tape insertion for urinary stress incontinence. Rports of her investigations for fitness for anesthesia were all normal . She had no other illness except for the urinary stress incontinence. She went through the preoperative preparation uneventfully. On the OT table, they inserted the intravenous line and attached the chest leads for heart monitor and the probe for pulse oximetry. The surgeons got ready awaiting induction of anesthesia. But there was some disturbance around the patient and a definite delay in induction of anesthesia. Time being a precious thing in our OT management, I had to find out the nature of the problem that was holding things up.
"Is there a problem?" I asked the anesthesiologists.
"She has acute upper abdominal pain" the anesthesiologist said. "We have given her ranitidine and an antispasmodic. If the pain is relieved, we will give her anesthesia.
"Where does it hurt you" I asked the patient.
"Here" she pointed towards her epigastrium.
"When did the pain start?" I asked her.
"I get it sometimes. Today it started in the midmorning."
There were no local findings on examination. The pain did not go away. So we postponed her operation and sent her back to the ward.
She is well fed patient, I thought, looking at her body weight.
"She will go back to the ward and eat to her heart’s content" said our Associate Professor who had been watching the event with some amusement. That was almost an echo of what I had thought. The pain was just hunger pangs, the patient being kept starving overnight for surgery. The patient’s pain was relieved after eating. No cause has been found for her abdominal pain after evaluation by appropriate specialists.
"Shall we post her for surgery?"
"We can do that. But what do we do if she cannot stand the hunger pangs again?" I said. "If we book the OT time for her and have to postpone the operation again, another patient who could have been operated on in that time would be denied treatment."
"So what can we do?"
"We could give her a stomach wash with lignocaine solution on the morning of the operation. It has not been done before. But you have to think out of the box to find a solution to a unique problem."
They stared at me, wondering if I was serious or just sarcastic.
