Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS)

Kluger, M. T.; Short, Timothy G.

doi:10.1046/j.1365-2044.1999.00642.x

Cited by 208 publications

(152 citation statements)

References 23 publications

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“…While no deaths occurred due to aspiration in our study, death rates in patients who aspirated range from 3.8% in the Australia Incident Monitoring Study [32], to 4.6% in the Sweden Study [30]. Some suggested risk factors for aspiration include the urgency of surgery, airway problems, inadequate depth of anesthesia, use of the lithotomy position, gastrointestinal problems, depressed consciousness, increased severity of illness and obesity [33].…”

Section: Airway and Respiratory Incidentsmentioning

confidence: 56%

Analysis of Critical Incidents during Anesthesia in a Tertiary Hospital

Zeng¹,

Ng²,

Thong³

2016

IJCM

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Introduction: Critical incident monitoring is important in quality improvement as it identifies potential risks to patients by analyzing adverse events or near-misses. Methods: This study analyses the reported incidents in a tertiary hospital over a 4-year period. Results: A total of 441 incidents were reported out of 98,502 anesthetics performed during the study period. Of these incidents, 67 resulted in no harm caused, 116 with unanticipated ICU admissions and 20 mortalities. The odds of having a critical incident increased with ASA status: from an odds ratio of 2.08 (95% CI: 1.58 to 2.74) for ASA 2 patients compared to ASA1, to OR of 13.70 (5.91 to 31.74) in ASA 5 compared to ASA 1. Critical incidents also have higher odds occurring out of hours (OR 1.7 (1.45 to 2.23) compared to daytime hours (08:00-17:00). They occurred most commonly in maintenance phase (142, 32.7%), followed by induction (120, 27.6%). The most common types of incidents include airway and respiratory (110, 24.9%) followed by drug related incidents (67, 15.2%). Human error was attributed as a significant contributing factor in 276 incidents (61.5%) followed by patient factors in 112 incidents (25.4%). Mitigating factors such as vigilance by staff involved were significant in 136 incidents (30.3%). Conclusion: Higher ASA status appears to be the most important factor associated with actual or potential patient harm in our study. Also significant, was time of incident, with incidents more likely out of hours. Critical incident reporting is a valuable part of quality assurance. We should continue to invest in incident reporting, incident analysis and improvement plans.

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Section: Airway and Respiratory Incidentsmentioning

confidence: 56%

Analysis of Critical Incidents during Anesthesia in a Tertiary Hospital

Zeng¹,

Ng²,

Thong³

2016

IJCM

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“…These outliers probably represent patients with an undetected gastric disorder such as functional dyspepsia (34)(35)(36). In patients with gastro-oesophageal reflux or if active vomiting occurs, even smaller gastric volumes may be propelled up and into the trachea (2,7,43) (Fig. 1).…”

Section: Gastric Content and Gastro-oesophageal Refluxmentioning

confidence: 99%

“…Airway management problems frequently precipitate pulmonary aspiration (3)(4)(5)(6)(7). Air blown into the stomach and bucking and coughing due to light anaesthesia may all cause gastro-oesophageal reflux episodes.…”

Section: Patient and Anaesthetic Factorsmentioning

confidence: 99%

“…# Acta Anaesthesiologica Scandinavica 49 (2005) A NAESTHESIA-RELATED pulmonary aspiration leading to respiratory failure (Aspiration Pneumonitis; Mendelson's syndrome) has been described in both elective and emergency surgical patients (1)(2)(3)(4)(5)(6)(7). With the hope of reducing the risk of this complication, rigid fasting routines before surgery have been enforced (8).…”

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confidence: 99%

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Pre‐operative fasting guidelines: an update

Søreide

Eriksson

Hirlekar

et al. 2005

Acta Anaesthesiol Scand

226

106

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Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children <6 months, most recommendations now allow breast-or formula milk feeding up to 4 h before anaesthesia. Recently, the concept of pre-operative oral nutrition using a special carbohydrate-rich beverage has also gained support and been shown not to increase gastric fluid volume or acidity. Based on the available literature, our Task Force has produced new consensus-based Scandinavian guidelines for pre-operative fasting. What is still not clear is to what extent the new liberal fasting routines should apply to patients with functional dyspepsia or systematic diseases such as diabetes mellitus. Other still controversial areas include the need for and effect of fasting in emergency patients, women in labour and in association with procedures done under 'deep sedation'. We think more research on the effect of various fasting regimes in subpopulations of patients is needed before we can move one step further towards completely evidence-based pre-operative fasting guidelines. Accepted for publication 16 March 2005Key words: Anaesthesia; general; gastric content; gastric emptying; preoperative fasting; pulmonary aspiration complications. # Acta Anaesthesiologica Scandinavica 49 (2005)A NAESTHESIA-RELATED pulmonary aspiration leading to respiratory failure (Aspiration Pneumonitis; Mendelson's syndrome) has been described in both elective and emergency surgical patients (1-7). With the hope of reducing the risk of this complication, rigid fasting routines before surgery have been enforced (8). However, the scientific basis for these rigid fasting routines in elective patients has been challenged and found to be nonexistent (9-11). Based on this new information, several national anaesthesia societies now have accepted more liberal fasting rules for clear fluids (water, clear juices, coffee, tea) (12-17). Intake of solids in the morning of elective surgery is still not recommended.To what extent pre-operative fasting is of any importance in emergency cases is still a matter of uncertainty with variation in clinical practice. Further, it is also not clear to what extent specific patient populations with suspected or proven delayed gastric emptying need to be exempt from the new fasting guidelines (16,17). Recently, a new method for pre-operative optimization of the elective patient, oral nutrition with carbohydrates (16,18,19), has been introduced, but so far has not been widely implemented into clinical practice.This review aims to give an update on preoperative fasting and gastric content as a risk factor of pulmonary aspiration. We will focus on the development and experience with the new and more liberal clinical practice guidelines, but also present still controversial areas worth further research. Anaesthesia-related pulmonary aspiration: risk factors Gastric e...

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“…Today's wards and critical care units are staffed with doctors with less experience and reduced exposure to difficult airways. This is due to numerous factors including a reduction in the number of difficult airways that present late, shorter working hours, better airway equipment, increased use of supraglottic airways and a reduction in training opportunities [54,59,[128][129][130][131][132][133][134]. It is essential that frontline medical, nursing and allied health staff are competent to manage and assist with tracheostomy and other related airway emergencies if they work in a relevant clinical area [31,38,53,[135][136][137][138][139][140].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

et al. 2012

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SummaryAdult tracheostomy and laryngectomy airway emergencies are uncommon, but do lead to significant morbidity and mortality. The National Tracheostomy Safety Project incorporates key stakeholder groups with multi‐disciplinary expertise in airway management. , the Intensive Care Society, the Royal College of Anaesthetists, ENT UK, the British Association of Oral and Maxillofacial Surgeons, the College of Emergency Medicine, the Resuscitation Council (UK) the Royal College of Nursing, the Royal College of Speech and Language Therapists, the Association of Chartered Physiotherapists in Respiratory Care and the National Patient Safety Agency. Resources and emergency algorithms were developed by consensus, taking into account existing guidelines, evidence and experiences. The stakeholder groups reviewed draft emergency algorithms and feedback was also received from open peer review. The final algorithms describe a universal approach to managing such emergencies and are designed to be followed by first responders. The project aims to improve the management of tracheostomy and laryngectomy critical incidents.

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Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS)

Cited by 208 publications

References 23 publications

Analysis of Critical Incidents during Anesthesia in a Tertiary Hospital

Analysis of Critical Incidents during Anesthesia in a Tertiary Hospital

Pre‐operative fasting guidelines: an update

Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

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