Aspiration

Question 1

What risk factors pre-dispose to possible aspiration?

Answer 1

1. Inadequate anaesthesia
2. Pregnancy
3. Obesity
4. Difficult airway
5. Emergency surgery
6. Full stomach
7. Altered GI motility

Question 2

Which patients are likely to have delayed gastric emptying?

Answer 2

1. Metabolic disease (poorly controlled DM, renal failure, sepsis)
2. Decreased motility (head injuries, myotonias)
3. Pyloric obstruction
4. GORD
5. Raised intra-abdominal pressure (obesity, pregnancy)
6. Opioids
7. Trauma (includes ileus from recent GI surgery)

Question 3

What are the signs of possible aspiration?

Answer 3

1. Obvious regurgitation
2. Gastric contents in airway device or oropharynx
3. High airway pressure and wheeze
4. Laryngospasm
5. Respiratory distress
6. Desaturation

Question 4

Outline a management plan for suspected aspiration

Answer 4

1. Apply cricoid unless pt is actively vomiting
2. Call for help
3. Position head down and (L) lateral
4. Suction the pharynx/larynx
5. Secure the airway and suction out the ETT
6. Ventilate with 100% O2
7. Expect bronchospasm and treat as appropriate
8. Insert NGT and empty stomach
9. Cancel elective surgery, proceed with emergency surgery
10. Decide whether aspiration is significant

Question 5

What suggests a likely significant aspiration?

Answer 5

1. Solid materal suctioned from trachea
2. Contaminated aspirate
3. Metabolic acidosis
4. Ongoing hypoxia, chest signs, need for ventilatory support

Question 6

What subsequent management may be necessary for a patient post aspiration?

Answer 6

1. Perform bronchoscopy and admit to ICU if significant aspiration
2. Document
3. Medical review if pt discharged to ward
4. CXR
5. No evidence to support routine ABs or steroids

Question 7

What measures can be used to decrease the risk of pulmonary aspiration?

Answer 7

1. Fasting
2. Chemical control of gastric acidity
3. Prokinetics
4. RSI with adequate cricoid pressure*
5. Suction readily available