aspiration

(May-2006 Q1) List the predisposing factors for aspiration of gastric contents in a patient undergoing general anaesthesia. Discuss the measures you would take to prevent this complication.

Predisposing factors :

1) patient factors

- GERD

- Pregnancy

- inadequate fasting : 8 hours or more for fatty food, 6 hours for milk or solids, 2 hours clear feeds, 3-4 hours for breast milk in <4 month old infants

- type of food

- medications that slow gastric emptying: opioids

- distracting injuries: trauma

- GI stasis: I/O

2) surgical factors

- laparoscopic surgery

3) anaesthesia factors

- use of a supraglottic device

- gastric insufflation with BV ventilation

- no RSI

altered consciousness/ severe TBI (GCS),

loss of laryngeal reflexes eg stroke/ Parkinson’s

difficult airway

pre op

prevent aspiration

-await gastric emptying if possible

reducing morbidity from aspiration: with reducing volume and acidity : adequate fasting , prokinetics, PPI or antacids/ H2 antagonists

inducing with head up position/shoulder roll/ avoid BVM , intubate with RSI, inflate cuff appropriately

ryles tube to reduce gastric contents

extubate awake