Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome.
OBJECTIVE
To determine the incidence of, outcome of, and risk factors for anesthesia-related pulmonary aspiration in the predominantly pediatric population receiving anesthesia care.


METHODS
Using a clinical concurrent quality assessment system we developed, we used data stored in a custom-designed computerized database to initiate a retrospective review. Statistical relationships were analyzed by Fisher's exact test and binary logistic regression with commercially available software.


METHODS
University-affiliated pediatric hospital.


METHODS
All patients receiving anesthesia (n = 50,880) between April 1, 1988, and March 31, 1993.


RESULTS
Aspiration occurred in 52 (0.10% or 10.2 per 10,000) of the 50,880 general anesthesia cases. Aspirate was food or gastric contents in 25 cases (0.049% or 4.9 per 10,000), blood in 13 (0.026% or 2.6 per 10,000), and unknown material in 14 (0.0275% or 2.76 per 10,000). There were no deaths attributable to aspiration. Morbidity was confined to unanticipated hospital admission (n = 12), cancellation of the surgical procedure (n = 4), and intubation, with or without ventilation (n = 15). Aspiration occurred significantly more often in patients with greater severity of underlying illness (ASA physical status III or IV) (p = 0.0015), intravenous induction (p = 0.0054), and age equal to or greater than 6.0 years and less than 11.0 years (p = 0.0029). Emergency procedures had a marginally significant increased aspiration risk (p = 0.0527).


CONCLUSIONS
The overall incidence of anesthesia-related aspiration in our series (0.10%) was twice that reported in studies of adults, and four times (0.25%) higher for those at highest risk (ASA physical status III or IV vs. physical status I or II). Anesthesia-related pulmonary aspiration was proven to be a rare event in this tertiary pediatric center and its consequences relatively mild. Because of the very low frequency and the lack of serious outcome after aspiration in ASA physical status I and II pediatric patients, it appears that routine prophylactic administration of histamine blockers or propulsive drugs in healthy pediatric patients is unwarranted.
Borland
L M
LM
Department of Anesthesiology/Critical Care Medicine, Children's Hospital of Pittsburgh, PA 15213-2583, USA.
Sereika
S M
SM
Woelfel
S K
SK
Saitz
E W
EW
Carrillo
P A
PA
Lupin
J L
JL
Motoyama
E K
EK
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000768:Anesthesia, General; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005215:Fasting; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome