[Current status of pulmonary aspiration associated with general anesthesia: a nationwide survey in Japan].
BACKGROUND
Aspiration has been considered as a morbid complication of anesthesia. The current status of anesthesia-associated pulmonary aspiration, however, has not yet been assessed in modern Japanese anesthesia practices.


METHODS
A written questionnaire was sent to all of the Japanese anesthesia-teaching hospitals certified by the Japan Society of Anesthesiologists and 56% of questionnaires were recovered and analyzed.


RESULTS
In the year 2002, 58 cases of pulmonary aspiration were reported (approximately 0.8/ 10,000 anesthesia cases). Approximately one-third of patients with aspiration subsequently suffered severe pulmonary complications necessitating mechanical ventilation and/or admission to the intensive care unit. Mortality in patients with aspiration was 5% (3/57; 1/250,000 anesthesia cases). Predisposing factors of emergency abdominal surgery with bowel obstruction, but not short fasting period, appeared to be associated with occurrence of severe pulmonary aspiration. Unproven therapies for aspiration were frequently applied, including bronchial toileting, systemic high-dose steroids and prophylactic antibiotics.


CONCLUSIONS
Aspiration remains a significant complication, even in modern anesthesia practices. Given the high morbidity and few proven therapies, nationwide clinical trials should be conducted and national therapeutic guidelines should be established in Japan.
Shime
Nobuaki
N
Department of Anesthesiology, Postgraduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto.
Ono
Akira
A
Chihara
Eiichi
E
Tanaka
Yoshifumi
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires