The Incidence and Outcome of Perioperative Pulmonary Aspiration in a University Hospital: A 4-Year Retrospective Analysis

Abstract

We evaluated the current incidence and outcome of perioperative pulmonary aspiration (PPA) in the nonobstetric adult population at a tertiary university medical center. A 4-yr retrospective analysis (January 2001-December 2004) was conducted using both quality improvement data and the hospital-wide medical archive recording system. PPA was defined as either detection of nonrespiratory secretions from the tracheobronchial tree or development of new pulmonary symptoms and/or new abnormalities in chest radiographs within 24 hr postoperatively. Of 99,441 anesthetics, 14 cases had confirmed PPA. Seven of them (50%) occurred in connection with gastroesophageal procedures. All patients had one or more predisposing risk factors for PPA. PPA occurred under general anesthesia in 10 patients and under monitored anesthesia care in 4 patients. In general anesthesia cases, the aspiration was recognized immediately after induction in 5 patients and occurred during changing of the endotracheal tubes in 5. The PPA was detected during the surgical procedures in all the monitored anesthesia care cases. Six patients with confirmed PPA developed pulmonary complications, of which, one died. Ten of 14 (70%) cases of PPA were the result of improper anesthesia technique. The current incidence of PPA is 1 of 7103, with morbidity 1 of 16,573 and mortality 1 of 99,441.

Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation

“…Furthermore, pulmonary aspiration did not impact on mortality and morbidity, apart from two cases of ICU admission with a length of stay < 24 h. In the present study, both incidence and outcome of pulmonary aspiration were similar to those previously reported. Our incidence of pulmonary aspiration was 1:6571: this value is very close to that reported in the most recent paper (1:7103) [22], and it is within the range of values that have been reported in the last 20 years (from 1:3216 to 1:14 139) [22][23][24][25]. Similarly, our low incidences of mortality and morbidity attributable to pulmonary aspiration are in keeping with those reported in previous studies [22][23][24][25][26].…”

Point-of-care ultrasound defines gastric content and changes the anesthetic management of elective surgical patients who have not followed fasting instructions: a prospective case series

“…3 Furthermore, although effective preventive measures exist, inadequate risk assessment leading to inappropriate airway management is the likely root cause in many cases of aspiration. 4,19 A state-wide audit from Maryland on over 300,000 anesthetics suggests that the incidence may be higher than commonly thought (up to 1% of all surgical procedures) and that aspiration results in an eightfold increase in in-hospital mortality. 19,20 Serious morbidity, such as pneumonia, acute respiratory distress syndrome, multiple organ dysfunction, brain damage, and disability are common among survivors.…”

“…4,19 A state-wide audit from Maryland on over 300,000 anesthetics suggests that the incidence may be higher than commonly thought (up to 1% of all surgical procedures) and that aspiration results in an eightfold increase in in-hospital mortality. 19,20 Serious morbidity, such as pneumonia, acute respiratory distress syndrome, multiple organ dysfunction, brain damage, and disability are common among survivors. 19,20 The significance of pulmonary aspiration for patient safety is underscored by its inclusion as one of only three anesthesia-related items in the World Health Organization Surgical Safety Checklist (along with the risk of difficult airway management and equipment/pulse oximeter check).…”

Low-dose fentanyl and midazolam in outpatient surgical abortion up to 18 weeks of gestation

“…In combination, opioids and benzodiazepines have the potential for serious complications including respiratory depression and aspiration of gastrointestinal contents [8,9]. However, these risks must be considered within the context of the great comfort and pain relief these medications provide to patients [10,11].…”

“…Consequently, patient care may be delayed, or the patient may decide to undergo a painful procedure without sedation because she has eaten. Whether there is actually an increased risk of complications among patients who undergo conscious sedation after eating has been difficult to evaluate because pulmonary aspiration is a relatively rare event [9]. The American Society of Anesthesiologists' practice guidelines acknowledge that "the literature does not provide sufficient evidence to test the hypothesis that pre-procedure fasting results in a decreased incidence of adverse outcomes in patients undergoing either moderate or deep sedation" [2]; yet, the panel goes on to recommend fasting for all patients undergoing elective procedures who wish to receive conscious sedation.…”