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Chapter: Clinical Cases in Anesthesia : Full Stomach

If aspiration occurs, what are the usual course, treat-ment and prognosis?

If aspiration occurs, treatment is symptomatic. The oral pharynx should be suctioned at the time of the aspiration.

If aspiration occurs, what are the usual course, treat-ment and prognosis?

 

If aspiration occurs, treatment is symptomatic. The oral pharynx should be suctioned at the time of the aspiration. If the patient is supine, the head should be turned to the side to facilitate suctioning. The patient should also be placed in the Trendelenburg position to allow pooling of the regurgitant in the oropharynx, thereby lessening the volume aspirated. Irrigation of the airway is not advised since it may cause spreading of the aspirate and a more profound pulmonary destruction. Bronchoscopy may be needed to remove large particulate matter. Supplemental oxygen should be administered. Mechanical ventilation is often necessary. 


β2 inhalers may be helpful for treatment of bronchospasm. The routine use of steroids has not been shown to be beneficial. Antibiotics should only be started after evidence of infection by positive culture.

 

If a clinically significant aspiration has occurred, signs usu-ally occur within 2 hours of the event. Signs include bron-chospasm, a drop in oxygen saturation of greater than 10% from baseline on room air, an alveolar-arterial (A-a) gradient of >300 mmHg on 100% O2, and a chest radiograph usually revealing atelectasis or an infiltrate (most commonly a right lower lobe infiltrate). Intrapulmonary damage can progress to interstitial and alveolar edema, with hyaline membrane formation and destruction of lung tissue. Adult respiratory distress syndrome (ARDS) often occurs in patients requiring more than 24 hours of mechanical ventilation. The progno-sis in patients with pulmonary aspiration is usually good if there is good health preoperatively. A poor outcome has been associated with the presence of significant comorbid conditions.

 

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Clinical Cases in Anesthesia : Full Stomach : If aspiration occurs, what are the usual course, treat-ment and prognosis? |


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