Aspiration Pneumonitis: an Anesthesia Event of Concern

Abstract

Aspiration pneumonitis results from inadvertent dropping of water, gastric secretion or food particles into the respiratory tract, particularly the lungs. These foreign bodies stimulate the immune system, cytokines, leukocytosis and white blood cell aggregation as well as an inflammatory process, leading to intra-alveolar tissue damage. Subsequently, the ventilation and perfusion mismatch inevitably precedes severe hypoxemia and acute respiratory failure. The severity of signs and symptoms depends on the pH and the amount of aspirated particles, particulate or non-particulate. In anesthesia, aspiration pneumonitis represents an adverse event of concern during the administration of sedative or general anesthesia since all anesthetics alter patients’ limits of self-control and cause the digestive system to prolong gastric emptying time. The incidence could worsen during an emergency surgery. As a result, anesthesia personnel’s current focus is on prevention rather than cure, leveraging various integrated clinical practice guidelines, such as preoperative patient management, preoxygenation with high flow technique, endotracheal intubation, ventilation and consciousness stabilization. At present, the ultrasound method helps verify the characteristics of particles in the stomach just before anesthetic management because it can significantly cut down on aspiration pneumonitis incidences.