Masui. The Japanese journal of anesthesiology
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Since the risk of pulmonary aspiration was recognized in obstetric anesthesia in 1930's, numerous efforts have been made to reduce the incidence and severity of perioperative pulmonary aspiration: preoperative fasting, preoperative assessment of risk factors in perioperative pulmonary aspiration, emptying the stomach, rapid-sequence induction of anesthesia with cricoid pressure, and the use of a cuffed tracheal tube. With these efforts, the incidence of pulmonary aspiration has been reduced drastically, and aspiration is now rare. Nevertheless, recent large studies have shown that perioperative pulmonary aspiration is the main cause of anesthesia-related death or irreversible brain damage. In this special issue, experts summarize the current state of perioperative pulmonary aspiration, its diagnosis and treatment, risk factors of pulmonary aspiration, preoperative preventative methods, and appropriate anesthesia methods and airway management in patients at increased risk of pulmonary aspiration.
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Review
[Risk Factors of Perioperative Pulmonary Aspiration Related to Anesthesia, Devices and Operation].
Perioperative pulmonary aspiration is an infrequent but is still a leading cause of anesthesia-related morbidity and mortality. This article reviews risk factors of perioperative pulmonary aspiration related to anesthesia, devices and operation. The most consistent risk factors related to anesthesia are light anesthesia, residual neuromuscular blockade after anesthesia, intermittent positive pressure ventilation particularly with high airway pressure, and prolonged anesthesia. ⋯ Even if patients have no predisposing factors, they may become at risk of pulmonary aspiration from a surgical procedure. Patients who are undergoing emergency procedures, bariatric surgery, upper abdominal surgery and laparoscopic surgery should be considered at risk. Lithotomy or the head-down position may also encourage residual gastric contents to regurgitate.
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Randomized Controlled Trial
[The McGRATH MAC Video Laryngoscope Facilitates Probe Insertion during Transesophageal Echocardiography].
A transesophageal echocardiography (TEE) probe is often inserted blindly. However, it is desirable to insert it under visual guidance because the blind technique sometimes causes difficulty and may contribute to serious, but rare, complications. This prospective study compared the usefulness of TEE insertion between a brand-new McGRATH MAC video laryngoscope (McGRATH) and a Macintosh laryngoscope (Macintosh). ⋯ There were no failures of insertion in the McG Group. Resistance during insertion was lower with the McGRATH than Macintosh. The McGRATH was shown to be very useful when inserting TEE probes.
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Examination of the literature suggests that the incidence of aspiration pneumonia in the perioperative period is relatively infrequent. Since Mendelson's report of aspiration pneumonitis in 1946, the factors that contribute to the likelihood of aspiration have been identified, and numerous attempts for preventions for regurgitation or pulmonary aspiration have been made. ⋯ Second generation supraglottic airways may not reduce the risk of regurgitation, but may reduce the chance of aspiration if the mask position is correct and drain tube works well. Because the mortality and morbidity of aspiration pneumonia remain relatively high, the preoperative risk evaluation is very important to avoid regurgitation or aspiration.
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Comparative Study
[Comparison of Sedative and Analgesic Requirements in Children with and without Down Syndrome following Pediatric Cardiac Surgery].
Conflicting results have been reported on postoperative analgesia in pediatric patients with Down syndrome. We compared sedative and analgesic requirements following cardiac surgery between pediatric patients with and without Down syndrome. ⋯ In our study, all enrolled patients received adequate sedation and analgesia after pediatric cardiac surgery. Sedative and analgesic doses following pediatric cardiac surgery were not different between the groups of Down syndrome and non-Down syndrome.