Strategies for prophylaxis and treatment for aspiration.
The absolute incidence of aspiration is difficult to define because of its relatively low occurrence and difficulty in diagnosis. The gastric volume predisposing to aspiration is larger than 30 ml. Fasting times for fluids have reduced; however, a large meal may require 9 hours of preoperative fasting. Preoperative carbohydrate-enriched beverages may attenuate postoperative catabolism. Aspiration occurs most frequently during induction and laryngoscopy. Awake fibre-optic intubation may be a suitable alternative in high-risk cases for aspiration. The role of cricoid pressure in anaesthesia needs re-evaluation as radiological and clinical evidence suggest that it may be ineffective and may impede intubation and ventilation. Chemoprophylaxis does not reduce the severity of aspiration pneumonitis as gastric bile is unaffected by these agents and induces a worse pneumonitis than gastric acid. Patients may be discharged home 2 hours after aspirating provided they are clinically unaffected and have postoperative surveillance.
The Department of Anesthesia and Peri-Operative Medicine, 3181 SW Sam Jackson Park Road, Oregon Health and Sciences University, Portland, OR 97239, USA. kalinows@ohsu.edu
Christopher Peter Henry
CP
Kalinowski
Jeffery Robert
JR
Kirsch
D000328:Adult; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002648:Child; D005215:Fasting; D005746:Gastric Emptying; D006801:Humans; D015994:Incidence; D009765:Obesity / Q000150:complications; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D054328:Proton Pump Inhibitors; D012307:Risk Factors; D013392:Sucralfate / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D013392:Sucralfate