Christian C Apfel1, Norbert Roewer. 1. Department of Anesthesiology and Perioperative Medicine, Outcomes Research Institute, University of Louisville, Louisville, Kentucky 40202, USA. christian.apfel@louisville.edu
Abstract
PURPOSE OF REVIEW: Aspiration of gastric contents is a potentially life-threatening complication that has attracted much attention among anaesthesiologists. This review critically evaluates current knowledge and means by which aspiration can be prevented, and offers alternative management approaches. RECENT FINDINGS: Because of the low incidence of aspiration of gastric contents (approximately 1 aspiration/3000 general anaesthetic cases), gastric volume and pH have been used as surrogate end-points in many aspiration studies; however, the clinical relevance of these end-points is questionable. A few epidemiological studies have identified the impact of several risk factors. More importantly, they indicate that none of the generally accepted strategies can prevent aspiration in every patient. Because preventive strategies may not only be ineffective but may also exert additional risk (e.g. cricoid pressure, rapid sequence induction), the risk-benefit ratio for each technique must be reconsidered. We suggest a strategy in which these techniques can be used, but taking into consideration the individual's risk for pulmonary aspiration. SUMMARY: None of the currently accepted methods can completely prevent the occurrence of pulmonary aspiration. Because they may themselves carry risk, the risk-benefit ratio should be considered, perhaps in a ranked order. New approaches are promising but randomized controlled trials are needed to validate their effectiveness.
PURPOSE OF REVIEW: Aspiration of gastric contents is a potentially life-threatening complication that has attracted much attention among anaesthesiologists. This review critically evaluates current knowledge and means by which aspiration can be prevented, and offers alternative management approaches. RECENT FINDINGS: Because of the low incidence of aspiration of gastric contents (approximately 1 aspiration/3000 general anaesthetic cases), gastric volume and pH have been used as surrogate end-points in many aspiration studies; however, the clinical relevance of these end-points is questionable. A few epidemiological studies have identified the impact of several risk factors. More importantly, they indicate that none of the generally accepted strategies can prevent aspiration in every patient. Because preventive strategies may not only be ineffective but may also exert additional risk (e.g. cricoid pressure, rapid sequence induction), the risk-benefit ratio for each technique must be reconsidered. We suggest a strategy in which these techniques can be used, but taking into consideration the individual's risk for pulmonary aspiration. SUMMARY: None of the currently accepted methods can completely prevent the occurrence of pulmonary aspiration. Because they may themselves carry risk, the risk-benefit ratio should be considered, perhaps in a ranked order. New approaches are promising but randomized controlled trials are needed to validate their effectiveness.