A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

Abstract

Perioperative pulmonary aspiration of gastric contents has been, and continues to be, associated with severe morbidity and death despite recent advances in relevant guidelines and airway management. In this closed claim analysis, 115 cases of pulmonary aspiration were retrieved from the Anesthesia Closed Claims Database for the period between 2000 and 2015. Anesthesia malpractice claims associated with surgical, procedural, or obstetric anesthesia care were included, whereas claims associated with acute or chronic pain management were excluded. Death occurred in 57% of the claims and severe permanent injury occurred in another 14%. Risk factors that occurred in 10% ormore of cases included emergency procedure, gastrointestinal obstruction or other acute intra-abdominal process, body mass index . 35 kg/m, gastroesophageal reflux disease, diabetes mellitus, and recent oral intake (defined as more recent than standard nil per os recommendations). The presence of at least 1 aspiration risk factor was identified in 93% of the claims. Of the patients identified within the claims, 61% had either gastrointestinal obstruction or another intraabdominal process. Management of the aspiration event was judged to be substandard in 59% of the 115 claims. Comment: The findings from this study failed to confirm the application of cricoid pressure and rapid sequence induction as strategies for preventing aspiration. The authors note that although pregnancy and delivery have historically been considered major aspiration risk factors, only 3 of 115 patients in this series were pregnant. Because no definitive treatment for aspiration has been described to date, the best strategy for prevention is to avoid known risk factors.