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Intravenous anesthesia is commonly used during endoscopy. This approach greatly improves patient satisfaction with pain control. The risks of anesthesia are usually focused on the cardiopulmonary effects of anesthetics. The risk of pulmonary aspiration is often overlooked, unless there are other risk factors that may increase the incidence of pulmonary aspiration. Here, we report a patient with unexpected aspiration pneumonia after gastroscopy under intravenous anesthesia. We suggest that pulmonary aspiration should be taken into consideration as a risk associated with anesthesia for gastroscopy.

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