Crisis management during anaesthesia: regurgitation, vomiting, and aspiration

Kluger, M. T.; Visvanathan, T; Myburgh, John; Westhorpe, Rod

doi:10.1136/qshc.2002.004259

Cited by 37 publications

(29 citation statements)

References 11 publications

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“…1,2,7 Nevertheless, GI still remains a significant liability in children. 3,4 In addition, most paediatric patients who presented pulmonary aspiration during anaesthetic induction had predisposing factors such as gastrointestinal obstruction. 5 However, considering that the incidence of pulmonary aspiration in children was twice that reported in adult and age related, 7 efforts to reduce the risk of gastric regurgitation should seek to limit PAP during mask ventilation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Manual vs. pressure-controlled facemask ventilation for anaesthetic induction in paralysed children: a randomised controlled trial

Park

Kim

Lee

et al. 2016

Acta Anaesthesiol. Scand.

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Section: Discussionmentioning

confidence: 99%

“…3,4 The anaesthetic induction time is the most vulnerable period to gastric regurgitation. [5][6][7][8] During facemask ventilation, positive pressure may force gas into the stomach in addition to the gas flow into the lungs depending on the peak airway pressure (PAP).…”

mentioning

confidence: 99%

Manual vs. pressure-controlled facemask ventilation for anaesthetic induction in paralysed children: a randomised controlled trial

Park

Kim

Lee

et al. 2016

Acta Anaesthesiol. Scand.

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“…In 2005, Kluger et al reported the rate of aspiration and regurgitation in children to be 0.1%. (22) The risk factors reported to be associated with aspiration and regurgitation in children include greater severity of disease (ASA III-V), intravenous induction and emergency procedures. (23,24) According to Kluger et al, the mortality rate following aspiration varies between 1 in 35,000 to 1 in 72,000.…”

Section: Discussionmentioning

confidence: 99%

“…(23,24) According to Kluger et al, the mortality rate following aspiration varies between 1 in 35,000 to 1 in 72,000. (22) Other sequelae such as laryngospasm, desaturation and bronchospasm can also occur.…”

Section: Discussionmentioning

confidence: 99%

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetic

Wan¹,

Siow²,

Lee³

et al. 2013

SMedJ

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INTRODUCTIONThis study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore.METHODS Data pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter.RESULTS A total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children.CONCLUSION Critical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.

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“…Clinicians should have a low threshold for suspecting pulmonary aspiration, e.g. unexplained hypoxaemia, and a low threshold for planned admission to critical care facilities if this is suspected [41].…”

Section: Management and Protection Of The Airway Including Pulmonary mentioning

confidence: 99%

The principles and conduct of anaesthesia for emergency surgery

Gray

Morris

2012

Anaesthesia

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SummaryIn this second article we examine the principles underlying delivery of the components of anaesthesia. Topics considered include anaesthetic technique, management of the airway and lung ventilation, induction and maintenance of anaesthesia, patient monitoring including the place of cardiac output devices. We summarise recent research on the management of shock and sepsis syndromes including goal directed therapy and examine some controversies around intravenous fluid therapy. Finally, we discuss intra-operative awareness and challenges during emergence including perioperative cognitive dysfunction. Choice of anaesthetic techniqueOptimal anaesthetic technique is dependent upon an individualised assessment of patient and surgical requirements. Prospective, randomised, controlled trials of rival anaesthetic techniques, e.g. the GALA trial, are rare [1]. Emergency anaesthesia lacks this evidence base and extrapolations from meta-analyses typically fail to reach clear recommendations for clinicians [2]. The nature of surgery, patient co-morbidities, and urgency will frequently decide the anaesthetic choice but clinicians should remain mindful of the options of local or regional anaesthesia and sedation in appropriate patients, especially when a 'lesser' procedure becomes feasible e.g. percutaneous drainage. Management and protection of the airway including pulmonary aspirationThe fourth National Audit Project (NAP4) of the Royal College of Anaesthetists recorded the epidemiology and management of airway complications in UK practice and is essential reading [3]. It is emphasised that 25% of emergency airway management takes place outside operating theatres and since publication, several resources and recommendations have become available [4][5][6]. In the UK, out-of-theatre tracheal intubation frequently occurs in the absence of essential staff and equipment and capnography was not used in nearly a third of cases in a large observational study [7].Both difficult laryngoscopy and difficult tracheal intubation are more common in emergency patients, often outside the theatre setting [8,9]. One American study of non-theatre emergency tracheal intubation by experienced practitioners identified difficulties in over 10%, with over 4% suffering complications [10]. Predictors of complications included multiple attempts and poor views at laryngoscopy and intubation in a ward or emergency department setting. Human factors are increasingly recognised in airway complications and an unfamiliar environment during airway management is likely to be important [3].

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Crisis management during anaesthesia: regurgitation, vomiting, and aspiration

Cited by 37 publications

References 11 publications

Manual vs. pressure-controlled facemask ventilation for anaesthetic induction in paralysed children: a randomised controlled trial

Manual vs. pressure-controlled facemask ventilation for anaesthetic induction in paralysed children: a randomised controlled trial

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetic

The principles and conduct of anaesthesia for emergency surgery

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