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Anesthesiology184 papers

Perioperative pulmonary aspiration

Last edited: 4/13/2026

Overview

Perioperative pulmonary aspiration refers to the inhalation of gastric contents into the lungs during surgery, posing significant risks of respiratory complications, including hypoxemia and aspiration pneumonia 28.

Diagnosis

  • Clinical signs include acute respiratory distress, cyanosis, and hypoxemia post-induction of anesthesia 28.
  • Diagnostic imaging such as chest X-rays may reveal infiltrates or atelectasis 28.
  • Point-of-care ultrasound can help identify pneumonitis or other lung abnormalities 23.
  • Management

  • Preoperative Measures: Fasting protocols to reduce gastric volume and pH management (e.g., antacids, H2 blockers) 67.
  • Intraoperative Measures: Use of appropriate airway management techniques, including rapid sequence induction when indicated 28.
  • Postoperative Monitoring: Close respiratory monitoring, including pulse oximetry and frequent assessment for signs of aspiration 28.
  • Supportive Care: Mechanical ventilation support if respiratory failure occurs 28.
  • Special Populations

  • Pediatrics: Increased risk due to immature airway anatomy; careful fasting protocols and vigilant monitoring are crucial 57.
  • Elderly: Higher prevalence of comorbidities that may complicate aspiration; tailored fasting guidelines and cautious anesthesia management are recommended 28.
  • Key Recommendations

  • Implement strict preoperative fasting guidelines to minimize gastric volume and acidity 67 (Evidence: Strong).
  • Utilize rapid sequence induction techniques when there is a high risk of aspiration to protect the airway 28 (Evidence: Strong).
  • Employ point-of-care ultrasound for early detection of pulmonary complications post-surgery 23 (Evidence: Moderate).
  • Ensure vigilant postoperative respiratory monitoring, particularly in high-risk groups like the elderly and pediatric patients 28 (Evidence: Moderate).
  • Consider individualized fasting protocols based on patient-specific risk factors 57 (Evidence: Expert opinion).
  • References

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Landscape of Anesthesiology Perioperative Interventional Clinical Trials Registered in ClinicalTrials.gov. Anesthesiology 2025. link 6 Kanjia MK, Kurth CD, Hyman D, Williams E, Varughese A. Perspectives on Anesthesia and Perioperative Patient Safety: Past, Present, and Future. Anesthesiology 2024. link 7 Millan PD, Kleiman AM, Friedman JF, Dunn LK, Gui JL, Bechtel AJ et al.. The impact of hindsight bias on the diagnosis of perioperative events by anesthesia providers: A multicenter randomized crossover study. Journal of clinical anesthesia 2024. link 8 Otalora-Esteban M, Delgado-Ramirez MB, Gil F, Thabane L. Assessing the fragility index of randomized controlled trials supporting perioperative care guidelines: A methodological survey protocol. PloS one 2024. link 9 Szmulewicz C, Rouby P, Boyer C, Benhamou D, Capmas P. Interdisciplinary Simulation Courses to Train Residents on Communication of Unexpected Complications from Perioperative Care: A Randomized Comparison of Within-Event (Microdebriefing) and Postscenario Debriefing. Journal of surgical education 2024. link 10 Wacker J, Haller G, Hendrickx JFA, Ponschab M. A survey and analysis of peri-operative quality indicators promoted by National Societies of Anaesthesiologists in Europe: The EQUIP project. European journal of anaesthesiology 2024. link 11 van den Heuvel SA, van Boekel RL, Cox FJ, Ferré F, Minville V, Stamer UM et al.. Perioperative pain management models in four European countries: A narrative review of differences, similarities and future directions. European journal of anaesthesiology 2024. link 12 Wang Q, Cao M, Tao H, Fei Z, Huang X, Liang P et al.. Evidence-based guideline for the prevention and management of perioperative infection. Journal of evidence-based medicine 2023. link 13 Swerdlow B, Osborne-Smith L. 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MedEdPORTAL : the journal of teaching and learning resources 2023. link 18 Wongtangman K, Aasman B, Garg S, Witt AS, Harandi AA, Azimaraghi O et al.. Development and validation of a machine learning ASA-score to identify candidates for comprehensive preoperative screening and risk stratification. Journal of clinical anesthesia 2023. link 19 Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S et al.. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesthesia, critical care & pain medicine 2023. link 20 Watkins SC, de Oliveira Filho GR, Furse CM, Muffly MK, Ramamurthi RJ, Redding AT et al.. The Effect of Novel Decision Support Tools on Technical and Non-Technical Performance of Teams in Managing Emergencies. Journal of medical systems 2022. link 21 Bellini V, Valente M, Gaddi AV, Pelosi P, Bignami E. Artificial intelligence and telemedicine in anesthesia: potential and problems. Minerva anestesiologica 2022. link 22 Desai SR, Tang L, Hwang NC. Infection Control for Perioperative Ultrasonography and Echocardiography. Journal of cardiothoracic and vascular anesthesia 2022. link 23 Segura-Grau E, Antunes P, Magalhães J, Vieira I, Segura-Grau A. Minute Zero: an essential assessment in peri-operative ultrasound for anaesthesia. Anaesthesiology intensive therapy 2022. link 24 Fanning JP, Huth SF, Robba C, Grieve SM, Highton D. Advances in Neuroimaging and Monitoring to Defend Cerebral Perfusion in Noncardiac Surgery. Anesthesiology 2022. link 25 Chung EH, Truong T, Jooste KR, Fischer JE, Davidson BA. The Implementation of Communication Didactics for OB/GYN Residents on the Disclosure of Adverse Perioperative Events. Journal of surgical education 2021. link 26 Yuki K, DiNardo JA, Koutsogiannaki S. The Role of Anesthetic Selection in Perioperative Bleeding. BioMed research international 2021. link 27 Meineri M, Arellano R, Bryson G, Arzola C, Chen R, Collins P et al.. Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2021. link 28 Warner MA, Meyerhoff KL, Warner ME, Posner KL, Stephens L, Domino KB. Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis. Anesthesiology 2021. link 29 Santhirapala V, Peden CJ, Meara JG, Biccard BM, Gelb AW, Johnson WD et al.. Towards high-quality peri-operative care: a global perspective. Anaesthesia 2020. link 30 Chen R. Synopsis of the point-of-care ultrasound assessment for perioperative emergencies. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2019. link 31 Conlon TW, Lin EE, Bruins BB, Manrique Espinel AM, Muhly WT, Elliott E et al.. Getting to know a familiar face: Current and emerging focused ultrasound applications for the perioperative setting. Paediatric anaesthesia 2019. link 32 Vagnoli L, Bettini A, Amore E, De Masi S, Messeri A. Relaxation-guided imagery reduces perioperative anxiety and pain in children: a randomized study. European journal of pediatrics 2019. link 33 Yasak K, Vural F. Assessment of the Environmental and Physical Ergonomic Conditions of ORs in Turkey. AORN journal 2019. link 34 Heller JA, Bhora FY, Heller BJ, Cohen E. Robotic-assisted thoracoscopic lung surgery: anesthetic impact and perioperative experience. Minerva anestesiologica 2018. link 35 Liem VGB, Hoeks SE, van Lier F, de Graaff JC. What we can learn from Big Data about factors influencing perioperative outcome. Current opinion in anaesthesiology 2018. link 36 Teja BJ, Sutherland TN, Barnett SR, Talmor DS. Cost-Effectiveness Research in Anesthesiology. Anesthesia and analgesia 2018. link 37 Kreth S, Hübner M, Hinske LC. MicroRNAs as Clinical Biomarkers and Therapeutic Tools in Perioperative Medicine. 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Assessment of Perioperative Ultrasound Workflow Understanding: A Consensus. Journal of cardiothoracic and vascular anesthesia 2017. link 43 Alem N, Cohen N, Cannesson M, Kain Z. Transforming Perioperative Care: The Case for a Novel Curriculum for Anesthesiology Resident Training. A & A case reports 2016. link 44 Watkins SC, Anders S, Clebone A, Hughes E, Zeigler L, Patel V et al.. Paper or plastic? Simulation based evaluation of two versions of a cognitive aid for managing pediatric peri-operative critical events by anesthesia trainees: evaluation of the society for pediatric anesthesia emergency checklist. Journal of clinical monitoring and computing 2016. link 45 Vetter TR, Barman J, Boudreaux AM, Jones KA. Perceptions about the relative importance of patient care-related topics: a single institutional survey of its anesthesiologists, nurse anesthetists, and surgeons. BMC anesthesiology 2016. link 46 Quick J. I could never do research. 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    Original source

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