Pulmonary Aspiration in Pediatric Patients During General Anesthesia

Borland, Lawrence M.; Sereika, Susan M.; Woelfel, S. K.; Saitz, Edward W.; Carrillo, Pamela A; Lupin, Judy L; Motoyama, Etsuro K.

doi:10.1097/00132586-199812000-00030

Cited by 73 publications

(136 citation statements)

References 0 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…(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. (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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Wan¹,

Siow²,

Lee³

et al. 2013

SMedJ

View full text Add to dashboard Cite

show abstract

“…95,127,129,173,244,261 Therefore, standard practice for fasting before elective sedation generally follows the same guidelines as for elective general anesthesia; this requirement is particularly important for solids, because aspiration of clear gastric contents causes less pulmonary injury than aspiration of particulate gastric contents. 262,263 For emergency procedures in children undergoing general anesthesia, the reported incidence of pulmonary aspiration of gastric contents from 1 institution is ∼1 in 373 compared with ∼1 in 4544 for elective anesthetics. 262 Because there are few published studies with adequate statistical power to provide guidance to the practitioner regarding the safety or risk of pulmonary aspiration of gastric contents during procedural sedation, 95, 127, 129, 173, 244, 259-261, 264-268, it is unknown whether the risk of aspiration is reduced when airway manipulation is not performed/ anticipated (eg, moderate sedation).…”

Section: Dietary Precautionsmentioning

confidence: 99%

“…268,269 Although emergency medicine studies and practice guidelines generally support a less restrictive approach to fasting for brief urgent/ emergent procedures, such as care of wounds, joint dislocation, chest tube placement, etc, in healthy children, further research in many thousands of patients would be desirable to better define the relationships between various fasting intervals and sedation complications. [262][263][264][265][266][267][268][269][270] …”

Section: Dietary Precautionsmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

Coté¹,

Wilson²

2016

Pediatrics

254

199

View full text Add to dashboard Cite

The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age-and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, suffi cient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the

show abstract

“…In one study, almost all cases of pulmonary aspiration occurred in children who gagged or coughed during airway management, either because neuromuscular blockade was not administered or airway manipulation occurred before the child was completely paralyzed [15]. Mortality due to pulmonary aspiration is low, with an estimated incidence between zero and 1:50,000 [15,16,18].…”

Section: Asa VImentioning

confidence: 99%