The Concept of Superposition of Clinical States Applied to Assess Preoperative Fasting

<p>To minimize the risk of pulmonary aspiration, preoperative fasting is a fundamental component and a cornerstone of safe anesthesia practice. However, the strict time-based fasting protocols that are frequently used in current guidelines fail to adequately account for the inherent uncertainties and unknowns that may exist in unclear situations of gastric emptying (uncertainties in patient histories, comorbidities, and physiological states). In this conceptual editorial we suggest an emerging term and concept of superposition of clinical states inspired by quantum mechanics. By analogy to Schrödinger’s quantum thought, where a cat is simultaneously alive and dead until observed, we propose in unclear situations that the stomach before anesthesia exists in a state of superposition where the stomach is both full and empty at the same time. Binary thinking, which aims to determine whether a patient is fasting or not, can only be subjective in certain cases because it does not consider unknowns and uncertainties. Therefore, it is reasonable to expect that only direct observation, such as through gastric ultrasound, resolves this uncertainty.</p> <p>The Concept of Superposition of clinical states should improve how the anesthesia and critical care community assess preoperative gastric content. Also, this concept challenges the binary thinking in fasting protocols and highlights the need for point-of-care gastric ultrasound as a critical tool to individualize patient care.</p>