J Dent Anesth Pain Med.  2018 Apr;18(2):111-114. 10.17245/jdapm.2018.18.2.111.

Pulmonary aspiration during intubation in a high-risk patient: A video clip and clinical implications

• Koh GH
• Kim SH
• Son HJ
• Jo JY
• Choi SS
• Park SU
• Kim WJ
• Ku SW

• KMID: 2410144
• DOI: http://doi.org/10.17245/jdapm.2018.18.2.111

Abstract

We report a case of pulmonary aspiration during induction of general anesthesia in a patient who was status post esophagectomy. Sudden, unexpected aspiration occurred even though the patient had fasted adequately (over 13 hours) and received rapid sequence anesthesia induction. Since during esophagectomy, the lower esophageal sphincter is excised, stomach vagal innervation is lost, and the stomach is flaccid, draining only by gravity, the patient becomes vulnerable to aspiration. As the incidence of perioperative pulmonary aspiration is relatively low, precautions to prevent aspiration tend to be overlooked. We present a video clip showing pulmonary aspiration and discuss the literature concerning the risk of aspiration and its preventive strategies.

Keyword

Hypopharyngeal Cancer; Intubation; Respiratory Aspiration

MeSH Terms

Anesthesia
Anesthesia, General
Esophageal Sphincter, Lower
Esophagectomy
Gravitation
Humans
Hypopharyngeal Neoplasms
Incidence
Intubation*
Respiratory Aspiration
Stomach

Figure

• 

  Fig. 1 Preoperative chest X-ray showing right pleural thickening with no active lung lesion.

• 

  Fig. 2 (A) Immediate postoperative chest X-ray showing ill-defined ground-glass opacities with peri-bronchial thickening in the left upper lobe field. (B) At postoperative day 12, follow up chest X-ray shows complete resolution of the haziness in the left upper lobe field.

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