199 - Perioperative Aspiration Pneumonitis

Abstract

Pulmonary aspiration is the entry of gastric secretions or particulate matter into the respiratory tract and can occur from either passive regurgitation or active vomiting. Although perioperative pulmonary aspiration in children is uncommon, significant morbidity and mortality can result from subsequent pneumonitis. Risk factors for pulmonary aspiration during anesthesia unique to children include gastroesophageal reflux disease (GERD) of infancy, GERD after TEF repair, prematurity, cerebral palsy, and acute gastric distention in pediatric trauma patients. In general, the risk of severe pneumonitis increases with lower pH and higher-volume aspirates. Mechanical obstruction of aspirated material can result in profound hypoxemia. Treatment of pulmonary aspiration includes immediate oral suctioning and supplementation with oxygen, and tracheal intubation is often required. Broncheolar lavage is not recommeneded; however, bronchoscopy should be performed if mechanical obstruction of aspirated material is suspected. Corticosteroids have not been shown to reduce morbidity or mortality after pulmonary aspiration in children. Emperic antibiotic therapy should be reserved only for cases in which grossly contaminated material has been aspirated. To prevent regurgitation during induction of anesthesia, rapid-sequence induction can be used to minimize the vulnerable period between loss of consciousness and securing of the airway. Cricoid pressure has been used to prevent regurgitation of stomach contents; however, in infants and small children, the application of cricoid pressure can distort laryngeal anatomy and make intubation challenging.