Perioperative aspiration events in children: A report from the Wake Up Safe Collaborative

Abstract

Background Perioperative aspiration, while rare, is a serious complication of anesthetic care. Consequences of aspiration may include physical obstruction, wheezing, and pneumonia, resulting in mild to severe hypoxemia and even death. Aim We used a multi‐institutional registry of pediatric patients to identify factors that influence the rate and resulting harm of perioperative pulmonary aspiration. Methods The Wake Up Safe registry was queried for all severe adverse events reported from 29 institutions from 2010 to 2017. Aspiration events were identified through the “respiratory adverse event” data entry form or through free text search. Multivariable regression was used to predict aspiration events, and contributory factors were identified by reviewing free text case comments. Results Analysis included 2 440 810 anesthetics administered involving patients ≤18 years of age. There were 135 pulmonary aspiration events, for an incidence of 0.006%. Within these 135 cases, 110 cases (82%) resulted in escalation of care and 51 (38%) resulted in patient harm, including 2 deaths (1.5%). In multivariable analysis, patients undergoing emergency surgery (OR 2.0 [1.2‐3.5]) or with higher ASA status were more likely to experience aspiration (ASA 3 (OR 5.0 [2.6‐9.1]); ASA ≥ 4 (OR 5.5 [3.8‐16.8])). Noted causes of aspiration included gastrointestinal comorbid conditions (19%), postcoughing event or laryngospasm (14%), nil per os (NPO) violation (11%), blood or secretions in the airway following or during the procedure (6%), and oral premedication reaction (3%). Conclusion Although infrequent, death was reported as a consequence of perioperative aspiration in two patients. The frequency with which NPO violations were identified as a potential cause of aspiration highlights the struggles institutions face with adherence to NPO regulations, as these cases may be preventable. Furthermore, preventive measures may be needed to address other common causes of aspiration, such as gastrointestinal comorbid conditions.

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

“…PA can result in aspiration pneumonia, aspiration pneumonitis, acute respiratory distress syndrome (ARDS), and subsequent bacterial infection through particle-, acid-and bacteriarelated mechanisms (2). Over the recent years, studies on PA have concentrated on pediatric patients (3)(4)(5)(6). To our knowledge, no large retrospective observational study on PA incidence in adults or all ages has been published since 2009 (7,8).…”

Fasting in pediatric anesthesia: the art of making simple things complex

“…Data extraction was based on 15 studies (Table 1, Ref. [2,[7][8][9][10][11][12][13][14][15][16][17][18][19]). These include studies on children ranging in age from preterm neonates at 28 weeks gestation to 18 years.…”

“…In children, regurgitation of gastric content to the lower airways (= pulmonary aspiration) may cause hypoxia or respiratory insufficiency, and is hence a serious but rare event with reported incidences of 0.6-9.3/10,000 [1,2]. In order to prevent PA, preoperative fasting of 6 hrs for solids and formulas, 4 hrs for breast milk and 1 hr for clear fluids is recommended, and endorsed by many societies (e.g., the Association of Paediatric Anaesthetist of Great Britain and Ireland (APAGBI), the European Society for Paediatric Anaesthesiology (ESPA) and L'Association des Anestheśistes-Reánimateurs Ped́iatriques d'Expression Franc aise) [3][4][5].…”

Perioperative anaphylaxis in children: A report from the Wake‐Up Safe collaborative

“…Before inclusion, reporting institutions analyze each event using a standardized root cause analysis method to evaluate the reasons responsible for the adverse event and determine the degree of preventability. Published data using WUS registry have included medication errors, cardiac arrests in the postanesthesia care unit (PACU), and severe adverse events in off‐site locations 7‐12 …”