Aspiration during anaesthesia: a computer‐aided study of 185 358 anaesthetics

Abstract

In order to estimate the incidence and significance of aspiration during anaesthesia, a study of cases in which this complication had occurred was made at the Karolinska Hospital. With the aid of the anaesthetic recordkeeping system of the Department of Anaesthesia and the computer-based register of diagnoses of in-patients at the hospital, all cases in which aspiration was recorded were retrieved. Eighty-three cases of aspiration were retrieved from the file of anaesthetic records and four from the in-patient register. This constitutes an incidence of 4.7 aspirations in 10 000 anaesthetics, or 1 in 2131. The patients most often affected were children and the elderly. In 83% of the cases there were one or more preoperative factors indicating an increased risk for aspiration, such as emergency operation (38 cases, 43%), upper abdominal or emergency abdominal surgery (14 cases, 16%), a history indicating delayed gastric emptying (e.g. peptic ulcer/gastritis, pregnancy, obesity, unusual stress or pain, elevated intracranial pressure, 54 cases, 61%). In 29 cases (33%) there was a history indicating an increased risk of regurgitation, e.g. nasogastric tube, oesophageal disease or pregnancy. In 15 cases of elective surgery, no history of increased risk for aspiration could be found. In 67% of those cases the aspiration was preceded by difficulties involving the airways or intubation. The incidence of aspiration was more than sixfold higher during the night than during regular daytime working hours. In 41 cases (47%) the aspiration led to aspiration pneumonitis confirmed by x-ray. Fifteen patients (17%) needed mechanical ventilation, and four died.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of Morning-Only Compared With Split-Dose Polyethylene Glycol Electrolyte Solution for Afternoon Colonoscopy: A Randomized Controlled Single-Blind Study

“…In one, of 2,000 healthy patients undergoing endoscopic procedures with nurse-administered propofol, there were five patients whose oxygen saturation fell to below 85% (19). Several conditions may be associated with increased incidence of pulmonary aspiration during general anesthesia, including extremes of age, male gender, pregnancy, difficult airway management, and factors that decrease gastric emptying, such as concurrent opioid administration, gastrointestinal obstruction or dysfunction, obesity, or depressed level of consciousness (20,21). Our patient who aspirated had no obvious risk factors for aspiration other than a BMI of 40 kg/m 2 , classifying her as morbidly obese.…”

Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study

“…[1][2][3][4] Certain factors have been linked to the severity of patient outcomes, including the volume, nature, and acidity of the aspirate. [5][6][7][8] The preoperative assessment of the risk of pulmonary aspiration relies essentially on the patient's history, and the clinical management typically adheres to fasting recommendations of current guidelines.…”

Large volume gastroesophageal reflux: a rationale for risk reduction in the perioperative period

“…Finally, another definition of the patient at risk may be inferred from the retrospective study of cases in which aspiration effectively occurred, such as the review by Olsson et al 14 Major predisposing factors in this study were: c~sophageal disease, the exlremes of age (especially the age group 0-9 years), emergency surgery, induction of anaesthesia outside daytime working hours, neurological disorders with decreased consciousness or elevated intracranial pressure, obesity and a history of peptic ulcer or gastritis. Inexperience of the anaesthetist was felt to be an aggravating factor by these authors.…”