Abstract
SummaryThe incidence of significant pulmonary aspiration in children is very low. Factors determining risk include the anaesthetist's experience, the child's ASA status, gastro‐oesophageal disease, obesity, intra‐abdominal obstruction, emergencies, trauma and the occurrence of laryngospasm. The diagnosis of pulmonary aspiration may be confused with post‐obstructive pulmonary oedema. Several approaches to risk reduction can be used and include appropriate pre‐operative fasting, acid aspiration prophylaxis and anaesthetic management. The widespread use of acid aspiration prophylaxis cannot be justified. Less emphasis should be placed on the ‘cut‐off’ values for gastric fluid contents of pH 2.5 and volume 0.4 ml·kg−1 in defining aspiration risk. Clear fluid fasts beyond 2–3 h do not result in reduced gastric fluid volume and if prolonged can be potentially harmful. It seems appropriate to use this interval in fasting guidelines for clear fluids. Recommended guidelines for solids vary from 4 h to no solids on the day of surgery.
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