While anesthesia is generally safe, respiratory complications such as anesthesia-related aspiration can be fatal. Occurring as often as 1 in every 2–3,000 operations requiring anesthesia,3 almost half of all patients who aspirate during surgery develop a related lung-injury, such as pneumonitis or aspiration pneumonia.
Aspiration of gastric contents is an undesirable and potentially preventable complication during anesthesia. Patients are at highest risk for aspiration at induction and emergence. Aspiration is commonly caused by coughing and straining during induction because of insufficient anesthesia.
According to the National Institutes of Health, this life-threatening, potentially fatal issue occurs in approximately 1 out of every 2,000 to 3,000 procedures that require anesthesia.
Foreign body aspiration can occur if loose items are unintentionally introduced into the airway during intubation, ventilation or advanced airway management. This can lead to partial or complete airway blockage or obstruction, and if the cause is not suspected, can be fatal.
Intraoperative pulmonary aspirations are rare events that occur in approximately one in 2,000 to 3,000 operations, but are potentially fatal complications associated with significant morbidity.
It can happen as a person swallows, or food can come back up from the stomach. Aspiration can lead to serious health issues such as pneumonia and chronic lung scarring. Aspiration pneumonia is known as a 'silent killer' and it can become deadly without many symptoms.
Elective patients should be fasted. The American Society of Anesthesiologists currently recommends the “2-4-6-8” rule of fasting to minimize the risk of vomiting and aspiration.
Precipitating factors in 57 aspiration related deaths.
All six large airway obstruction cases died within 72 hours of aspiration.
When pulmonary aspiration occurs during eating and drinking, the aspirated material is often colloquially referred to as "going down the wrong pipe". Consequences of pulmonary aspiration range from no injury at all, to chemical pneumonitis or pneumonia, to death within minutes from asphyxiation.
TARGET POPULATION: Dysphagia is common in persons with neurologic diseases such as stroke, Parkinson's disease, and dementia. The older adult with one of these conditions is at even greater risk for aspiration because the dysphagia is superimposed on the slowed swallowing rate associated with normal aging.
Pulmonary aspiration is a rare but potentially life-threatening complication of sedation, avoidance of which is the goal of preprocedural fasting guidelines.
Conclusion: Tracheotomy, epiglottic flap closure and stomach-stomy are all the effective surgical treatment for chronic severe aspiration.
Treatment includes supplemental oxygen, steroids, or help from a breathing machine. Depending on the cause of chronic aspiration, you may require surgery. For example, you may get surgery for a feeding tube if you have swallowing problems that don't respond to treatment.
Risk Factors: Medications
In and of itself, anesthesia places patients at risk for aspiration. This risk results from the effects of medications on the lower esophageal sphincter, level of consciousness, and loss of protective reflexes.
Aspiration is a life-threatening medical emergency. Mortality heavily depends on the volume of aspirate and the presence of contaminants, but can be as high as 70 percent.
Aspiration of foreign material into the lungs can represent a medical emergency requiring timely interventions to assure a favorable outcome. Establishment of a patent airway and maintenance of adequate oxygenation are the initial requirements for successful treatment of all types of aspiration emergencies.
If you're having general anesthesia, an anesthesiologist will give you medications that make you lose consciousness. After the surgery is complete, he or she will reverse the medication so that you regain consciousness — but you won't be wide awake right away.
An Anesthesiologist's Error Can Be Fatal
One of the potential complications is anesthesia aspiration. This occurs when a patient cannot swallow or vomits up food from his or her stomach until his or her lungs. This can lead to aspiration pneumonia and it can make it difficult to get enough oxygen.
Normally you swallow saliva and food without choking because part of the swallowing mechanism involves a reflex that covers the opening into the lungs When you are given anesthesia, you lose this ability to protect your lungs from inhaling things you're not supposed to inhale.
Symptoms such as vomiting and belching can cause aspiration in vulnerable patients. Older adults, those with a compromised airway or impaired gag reflexes, or the presence of oral, nasal, or gastric tubes are at an increased risk.
Aspiration does not always require medical treatment. However, if any of the following symptoms arise, call 911 or go to the emergency room: choking or a blocked airway. noisy breathing.
Diseases that affect swallowing or cause further inflammation may make aspiration pneumonia worse or prevent it from healing properly. Some severe infections may result in long-term damage and scarring in the lungs and major airways.
If particulate material is aspirated or the patient is in significant respiratory distress, endotracheal intubation followed by tracheal toilet is recommended. Removal of particulate matter may be aided by bronchoscopy.