Pulmonary aspiration in anesthesia: review

Perioperative aspiration is defined as the inhalation of oropharyngeal or gastric contents into the airways beyond the vocal cords. It occurs in approximately four per 10 000 anesthetic procedures with higher incidences in emergency situations and special patient groups, such as people with gastro-intestinal and esophageal abnormalities, those with altered states of consciousness, older and obstetric ones. Aspiration occurs more frequently during induction of anesthesia and tracheal extubation. The probability of an aspiration can be reduced by fasting, pharmacological interventions to reduce gastric volume and acidity, maintenance of a nasogastric tube, and correct anesthetic management using awake tracheal intubation or rapid sequence induction and intubation with Sellick manoeuvre. Aspiration of gastric content can lead to range of diseases such as pneumonitis, which is defined as acute lung injury after the regurgitated gastric content, or pneumonia, an infectious process, due to the inhalation of oropharyngeal secretion or stomachic lining contaminated by pathogenic bacterias. The treatment is based on suctioning after witnessed aspiration. If the particulated matter is assumed, a bronchoscopy should be performed and protective pulmonary ventilation. Antibiotics should not be given in the acute phase of aspiration. The choice of the antibiotic has to be given according to the clinical Pulmonary aspiration in anesthesia: review Flora Margarida Barra Bisinotto1, Luciano Alves Matias da Silveira2, Laura Bisinotto Martins3 Aspiração pulmonar em anestesia: revisão DOI: 10.5935/2238-3182.20140128