A 30-year-old woman with type 1 diabetes of 20 years duration presents for emergency laparoscopy. She has documented gastroparesis with postprandial vomiting, and her last meal was eight hours ago. Which airway strategy is most appropriate?

• A Laryngeal mask airway insertion after confirming eight hours of fasting
• B Routine mask induction with spontaneous ventilation
• C Awake tracheal intubation after topical anaesthesia
• D Standard rapid sequence induction with cricoid pressure ✓

Explanation

Diabetic autonomic neuropathy commonly impairs gastric motility, producing gastroparesis in which gastric emptying does not follow fasting intervals. Such a patient must be treated as having a full stomach regardless of the eight hour fast, mandating rapid sequence induction with cricoid pressure and a cuffed tracheal tube. Mask induction risks regurgitation and aspiration, an LMA does not protect the airway, and awake intubation is reserved for predicted difficult airways rather than aspiration risk alone.

Reference: Morgan and Mikhail's Clinical Anesthesiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.