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Chapter 11 - How to Avoid Morbidity from Aspiration of Gastric Content to the Lungs

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

By
Richard Vanner  and
Takashi Asai
Edited by
Tim Cook  and
Michael Seltz Kristensen
Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

Pulmonary aspiration of gastric contents during general anaesthesia can be fatal. A 1956 report identified pulmonary aspiration as the commonest cause of death during general anaesthesia and NAP4 reported similarly in 2011. Major efforts have been made to reduce its incidence. Cricoid pressure (force) was introduced in the 1960s but remains controversial. Recent studies and new techniques have shed further light on the debate. The role of second generation supraglottic airway devices and videolaryngoscopy is also discussed.

Keywords

Airwayaspirationcricoid forcecricoid pressuregastric contentspneumonitisrapid sequence inductionsecond generation supraglottic airwaystarvation
Type
Chapter
Information
Core Topics in Airway Management , pp. 91 - 96
Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Asai, T. (2016). Videolaryngoscopes: do they have role during rapid-sequence induction of anaesthesia? British Journal of Anaesthesia, 116, 317–319.Google Scholar
Birenbaum, A, Hajage, D, Roche, S, et al. (2019). Effect of cricoid pressure compared with a sham procedure in the rapid sequence induction of anesthesia The IRIS Randomized Clinical Trial. JAMA Surgery, 154, 9–17.Google Scholar
Kluger, MT, Short, TG. (2002). Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia, 54, 19–26.CrossRefGoogle Scholar
Salem, MR, Khorasani, A, Zeidan, A, Crystal, GJ. (2017). Cricoid pressure controversies. Anesthesiology, 126, 738–52.CrossRefGoogle ScholarPubMed
Vanner, RG, Asai, T. (1999). Safe use of cricoid pressure. Anaesthesia, 53, 1–3.Google Scholar
Warner, MA, Warner, ME, Weber, JG. (1993). Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology, 78, 56–62.Google Scholar

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