Strategies for prophylaxis and treatment for aspiration

Christopher Peter Henry Kalinowski, Jeffery Robert Kirsch

Research output: Contribution to journalArticle

53 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)719-737
Number of pages19
JournalBest Practice and Research: Clinical Anaesthesiology
Volume18
Issue number4
DOIs
StatePublished - Dec 2004

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Keywords

  • Aspiration
  • Carbohydrate-enriched fluids
  • Chemoprophylaxis
  • Cricoid pressure
  • Fibre-optic intubation
  • Preoperative fasting
  • Rapid sequence induction

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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