Acute Intraoperative Pulmonary Aspiration

Abstract

Synopsis Acute intraoperative aspiration is a potentially fatal complication with significant associated morbidity. Patients undergoing thoracic surgery are at increased risk for anesthesia-related aspiration, largely due to the predisposing conditions associated with this complication. Awareness of the risk factors, predisposing conditions, maneuvers to decrease risk and immediate management options by both the thoracic surgeon and the anesthesia team is imperative to reducing risk and optimizing patient outcomes associated with acute intraoperative pulmonary aspiration. Based on the root-cause analyses that many of the aspiration events can be traced back to provider factors, having an experienced anesthesiologist present for high-risk cases is also critical.

Anesthesia Fatality due to Bile Aspiration: Lessons to be Learnt

“…Aspiration is the commonest cause of anesthesia related fatality [1,2]. Recent literature has highlighted that patient selection; assessment of risk factors for aspiration is the best technique to mitigate risks of aspiration [1,2].…”

“…Recent literature has highlighted that patient selection; assessment of risk factors for aspiration is the best technique to mitigate risks of aspiration [1,2]. The pre-operative assessment and induction should ideally be carried out by the senior most anesthetists [1][2][3].…”

“…The pre-operative assessment and induction should ideally be carried out by the senior most anesthetists [1][2][3]. Rapid sequence induction (RSI) is the standard of care and should be actively considered in patients who have delayed gastric emptying time [1][2][3].…”

“…in NAP4 [3] (4th National Audit Project of the Royal College of Anesthetists, UK) study and other literature [1,2]. Importance of preoperative assessment and updated medical history is highlighted.…”

“…Patient selection and risk assessment should be stringent. Rapid sequence induction is still the universal practice of choice in any situations where GI motility is altered directly or indirectly [1,3].…”