Perioperative pulmonary aspiration and regurgitation without aspiration in adults: a retrospective observational study of 166,491 anesthesia records

Abstract

Background: Pulmonary aspiration (PA) of gastric contents is a rare but serious perioperative complication. Recent studies focused on pediatric patients, but over a decade has passed since the latest incidence and outcome in adult population have been reported. Patients who experienced regurgitation without aspiration were rarely mentioned. Besides, our department proposed a modified rapid sequence induction (RSI) protocol in 2018 and its preventive effect remained to be examined.Methods: A total of 166,491 anesthesia records from March 2015-October 2020 were reviewed. Outcomes from regurgitation events were classified as PA or regurgitation without aspiration following strict criteria.Available information including demographics, anesthetic managements, surgical procedures, and other medical records were reviewed for analysis.

Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety

“…A recent retrospective record study in 155 830 adults evaluated the standard 2 hours of fasting for clear fluids and reported an incidence of regurgitation in elective anesthesia of 0.6 per 10 000 patients. 12 This incidence is lower than in our population and likely to be attributed to the retrospective study design. The authors noticed that some anesthesiologists considered regurgitation without aspiration relatively innocent and were inclined not to record this, leading to an underestimation.…”

“…Although higher than anticipated, our current incidence of regurgitation matches the recent literature. 12,17 The German prospective multicenter observational (NIKS) study of 12 093 children evaluated the safety of a liberal fluid policy. 17 For children undergoing elective procedures after a fasting duration of 2.3 hours, the reported incidence of regurgitation was 32 per 10 000 patients, which is higher than in our study.…”

“…Inadequate implementation is, among other things, caused by fear of aspiration, anxiety, and loose flexibility in operating room scheduling . Although aspiration can lead to aspiration pneumonia and even death, its reported incidences are between 1 and 10 in 10 000 elective procedures . Recent studies, mainly in children, have shown that reducing fluid fasting times results in flexible operating room scheduling, reduced postoperative nausea and vomiting (PONV) and better patient well-being, without increasing aspiration risk …”

“…7 Although aspiration can lead to aspiration pneumonia and even death, its reported incidences are between 1 and 10 in 10 000 elective procedures. [11][12][13] Recent studies, mainly in children, have shown that reducing fluid fasting times results in flexible operating room scheduling, reduced postoperative nausea and vomiting (PONV) and better patient well-being, without increasing aspiration risk. [14][15][16][17][18][19] In response to these studies, European pediatric fasting guidelines relaxed their recommendations to allow intake of clear fluids until 1 hour before anesthesia.…”

Comparing suction rates of novel DuCanto catheter against Yankauer and standard suction catheter using liquids of different viscosity—a technical simulation

“…Following the first public demonstration of general anesthesia with ether by William Thomas Morton Open Access *Correspondence: wolfgang.wetsch@uk-koeln.de in 1846, James Young Simpson reported the first death due to pulmonary aspiration during chloroform induced anesthesia in 1848 [4]. Today, anesthesiologists, critical care and emergency doctors take multiple precautions in order to prevent pulmonary aspiration when inducing general anesthesia, but regurgitation of gastric content can occur despite all precautions, as a review of 166,491 anesthesia records in a recent study showed: in 20 cases, they found pulmonary aspiration, and in an additional 20 cases there were signs of regurgitation without pulmonary aspiration [5]. Pulmonary aspiration can have varying clinical consequences -ranging from clinically none, to aspiration pneumonia due to bacteria transported into the lung alongside with the aspirate, [6] right up to severe acute respiratory distress syndrome (ARDS) with distinct hypoxemia -named "Mendelson Syndrome" after Curtis L. Mendelson, who described a case series of 66 healthy obstetrical patients with chemical pneumonitis after ether anesthesia [7].…”