Detection of pulmonary aspiration of gastric contents in an animal model by assay of peptic activity in bronchoalveolar fluid

1996 ◽  
Vol 24 (11) ◽  
pp. 1881-1885 ◽  
Author(s):  
Michael M. Badellino ◽  
Robert F. Buckman ◽  
Paul J. Malaspina ◽  
C. Andrew Eynon ◽  
Gerald M. O'Brien ◽  
...  
Keyword(s):  
Animal Model ◽  
Pulmonary Aspiration ◽  
Peptic Activity ◽  
Gastric Contents ◽  
Bronchoalveolar Fluid

scholarly journals Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners

10.2196/15905 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e15905 ◽  
Author(s):  
Richard Neville Merchant ◽  
Navraj Chima ◽  
Olle Ljungqvist ◽  
Juliana Nai Jia Kok
Keyword(s):  
Fluid Intake ◽  
Evidence Base ◽  
Pulmonary Aspiration ◽  
Internet Survey ◽  
Preoperative Fasting ◽  
Clear Fluid ◽  
Safety Issues ◽  
Solid Foods ◽  
Gastric Contents ◽  
Operating Room Schedule

Background Pulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach. Despite a strong evidence base and the knowledge that fasting may be physiologically harmful and unpleasant for patients, the adoption of society guidelines recommending short fasting periods for clear fluids into clinical practice is uncertain. Objective This study aimed to determine the current practices of anesthetists with respect to fasting guidelines. Methods An electronic internet survey was distributed to anesthetists in Canada (CAN), Australia and New Zealand (ANZ), and Europe (EUR) during April 2014 to February 2015. The anesthetists were asked about fasting guidelines, their recommendations to patients for the consumption of clear fluids and solid foods, and the reasons and consequences if these guidelines were not followed. Results A total of 971 anesthetists completed the survey (CAN, n=679; ANZ, n=185; and EUR, n=107). Although 85.0% (818/962) of these participants claimed that their advice to patients followed current society guidelines, approximately 50.4% (476/945) enforced strict fasting and did not allow clear fluids after midnight. The primary reasons given were with regard to problems with a variable operating room schedule (255/476, 53.6%) and safety issues surrounding the implementation of clear fluid drinking guidelines (182/476, 38.2%). Conclusions Many anesthetists continue to follow outdated practices. The current interest in further liberalizing preoperative fluid intake will require more change in anesthesia culture.

PULMONARY ASPIRATION OF GASTRIC CONTENTS IN OBSTETRIC PATIENTS

1967 ◽  
Vol 11 (2) ◽  
pp. 152???153
Author(s):  
P. W. MCCORMICK ◽  
R. G. HAY ◽  
R. W. GRIFFIN
Keyword(s):  
Pulmonary Aspiration ◽  
Gastric Contents

Aspiration Pneumonitis

2017 ◽  
Author(s):  
Agnieszka Trzcinka
Keyword(s):  
Risk Factors ◽  
Delayed Gastric Emptying ◽  
Perioperative Period ◽  
Pulmonary Aspiration ◽  
Aspiration Pneumonitis ◽  
Anesthesia Induction ◽  
Supportive Treatment ◽  
Gastric Contents ◽  
Upper Abdominal ◽  
Risk Of Aspiration

Aspiration pneumonitis during the perioperative period is a serious complication and involves passage of sterile gastric contents into the airway resulting in alveolar damage. The mechanism of aspiration pneumonitis is characterized by a significant inflammatory reaction. The risk of aspiration is highest during anesthesia induction, but it is also present during emergence and extubation. The risk factors include delayed gastric emptying (gastritis, pain, pregnancy, obesity, elevated intracranial pressure), emergency surgery, upper abdominal surgery, and difficulty securing the airway. Anesthesiologists should focus on prevention of pulmonary aspiration with consideration of the patient’s NPO status and risk factors when planning anesthesia induction and emergence. If aspiration of gastric contents occurs, the patient may exhibit a variety of symptoms, with severity based on the volume and pH of the aspirate. Subsequently, patients with observed or suspected aspiration need supportive treatment that varies depending on the severity of symptoms.

Preoperative Fasting in the Pediatric Patient

2018 ◽  
Author(s):  
Nancy Hagerman ◽  
Eric Wittkugel
Keyword(s):  
Pediatric Patient ◽  
Venous Access ◽  
Pulmonary Aspiration ◽  
Evidence Based ◽  
Rare Occurrence ◽  
Preoperative Fasting ◽  
Prolonged Fasting ◽  
Gastric Contents ◽  
Difficult Venous Access ◽  
In Infants And Children

Preoperative fasting guidelines are designed to reduce the volume of gastric contents and to minimize the risk of pulmonary aspiration of gastric contents. Perioperative pulmonary aspiration in children is uncommon, with an incidence of between 1 and 10 per 10,000 anesthetics. It is associated with low morbidity and mortality. While fasting is important, it does not guarantee an empty stomach. Prolonged fasting in infants and children does not further reduce gastric volumes or increase safety but can be associated with unwanted effects such as irritability, parental dissatisfaction, hypoglycemia, dehydration, hypotension on the induction of anesthesia, difficult venous access, and possibly decreased compliance with the preoperative fast. Since pulmonary aspiration is a rare occurrence, few evidence-based recommendations for ideal fasting intervals exist. An understanding of the research involved in the creation of these guidelines is useful in ensuring the maximum safety of patients while minimizing the disadvantages of prolonged fasting.

PULMONARY ASPIRATION OF GASTRIC CONTENTS IN OBSTETRIC PATIENTS

The Lancet ◽  
1966 ◽  
Vol 287 (7447) ◽  
pp. 1127-1130 ◽  
Author(s):  
P.W. Mccormick ◽  
R.G. Hay ◽  
R.W. Griffin
Keyword(s):  
Pulmonary Aspiration ◽  
Gastric Contents

Perioperative Pulmonary Aspiration in Infants and Children 

1999 ◽  
Vol 90 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Mark A. Warner ◽  
Mary E. Warner ◽  
David O. Warner ◽  
Louise O. Warner ◽  
Jackson E. Warner
Keyword(s):  
Respiratory Symptoms ◽  
Postoperative Mortality ◽  
Pulmonary Complications ◽  
Pulmonary Aspiration ◽  
Infants And Children ◽  
Respiratory Morbidity ◽  
General Anesthetics ◽  
Emergency Procedures ◽  
Gastric Contents ◽  
In Infants And Children

Background Pulmonary aspiration of gastric contents during the perioperative period in infants and children may be associated with postoperative mortality or pulmonary morbidity. There has not been a recent determination of the frequency of this event and its outcomes in infants and children. Methods The authors prospectively identified all cases of pulmonary aspiration of gastric contents during the perioperative courses of 56,138 consecutive patients younger than 18 yr of age who underwent 63,180 general anesthetics for procedures performed in all surgical specialties from July 1985 through June 1997 at the Mayo Clinic. Results Pulmonary aspiration occurred in 24 patients (1: 2,632 anesthetics; 0.04%). Children undergoing emergency procedures had a greater frequency of pulmonary aspiration compared to those undergoing elective procedures (1:373 vs. 1:4,544, P < 0.001). Fifteen of the 24 children who aspirated gastric contents did not develop respiratory symptoms within 2 h of aspiration, and none of these 15 developed pulmonary sequelae. Five of these nine children who aspirated and in whom respiratory symptoms developed within 2 h subsequently had pulmonary complications treated with respiratory support (P < 0.003). Three children were treated with mechanical ventilation for more than 48 h, but no child died of sequelae of pulmonary aspiration. Conclusions In this study population, the frequency of perioperative pulmonary aspiration in children was quite low. Serious respiratory morbidity was rare, and there were no associated deaths. Infants and children with clinically apparent pulmonary aspiration in whom symptoms did not develop within 2 h did not have respiratory sequelae.

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