Korean J Crit Care Med.  2015 Nov;30(4):313-317. 10.4266/kjccm.2015.30.4.313.

Aspiration Pneumonia in a Pediatric Patient under General Anesthesia despite Adequate Preoperative Fasting

• Yoon SI
• Kang JM

• KMID: 2156187
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.313

Abstract

Aspiration pneumonia rarely occurs during general anesthesia; however, it can result in fatal pulmonary complications. To reduce aspiration pneumonia, a preoperative fasting time of 8 hours is recommended. A 4-year-old boy with ankyloglossia was scheduled for frenotomy. He completed preoperative fasting time and had no digestive symptoms. Pulmonary aspiration due to unexpected massive vomiting occurred during anesthesia induction. The patient's airway was immediately secured by endotracheal tube. The vomitus in the airway tract was removed by fiberoptic bronchoscopy. Abdomen radiograph taken after this event showed paralytic ileus which can cause aspiration of gastric contents. We describe a case of pneumonia caused by aspiration of gastric contents in a pediatric patient who followed fasting instructions and who was scheduled for outpatient surgery.

Keyword

aspiration pneumonia; fasting; general anesthesia

MeSH Terms

Abdomen
Ambulatory Surgical Procedures
Anesthesia
Anesthesia, General*
Bronchoscopy
Child, Preschool
Fasting*
Humans
Intestinal Pseudo-Obstruction
Male
Pneumonia
Pneumonia, Aspiration*
Vomiting

Figure

• 

  Fig. 1. Serial chest radiographs. (A) Preoperative normal chest radiograph. (B) Chest radiograph taken after endotracheal intubation: pneumonic infiltration can be seen on both lung fields. (C) Chest radiography taken one month after discharge: both lung fields are normalized.

• 

  Fig. 2. Abdominal radiography illustrating a paralytic ileus pattern.

Reference

References

1. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011; 114:495–511.

2. Shime N, Ono A, Chihara E, Tanaka Y. Current status of pulmonary aspiration associated with general anesthesia: a nationwide survey in Japan. Masui. 2005; 54:1177–85.

3. Lienhart A, Auroy Y, Péquignot F, Benhamou D, Warszawski J, Bovet M, et al. Survey of anesthesia-related mortality in France. Anesthesiology. 2006; 105:1087–97.

4. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001; 344:665–71.

5. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003; 124:328–36.

6. Warner MA, Warner ME, Warner DO, Warner LO, Warner EJ. Perioperative pulmonary aspiration in infants and children. Anesthesiology. 1999; 90:66–71.

7. Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol. 2007; 21:671–87.

8. Batke M, Cappell MS. Adynamic ileus and acute colonic pseudo-obstruction. Med Clin North Am. 2008; 92:649–70.

9. Camilleri M, Hasler WL, Parkman HP, Quigley EM, Soffer E. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology. 1998; 115:747–62.

10. Vantrappen G. Methods to study gastric emptying. Dig Dis Sci. 1994; 39(12 Suppl):91S–4S.

11. Smout A, Horowitz M, Armstrong D. Methods to study gastric emptying. Frontiers in gastric emptying. Dig Dis Sci. 1994; 39(12 Suppl):130S–2S.

12. Bolondi L, Bortolotti M, Santi V, Calletti T, Gaiani S, Labò G. Measurement of gastric emptying time by real-time ultrasonography. Gastroenterology. 1985; 89:752–9.

13. Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014; 113:12–22.

14. Sandora TJ, Harper MB. Pneumonia in hospitalized children. Pediatr Clin North Am. 2005; 52:1059–81. viii.