Anesth Pain Med.  2022 Apr;17(2):239-244. 10.17085/apm.21102.

Management of pulmonary aspiration due to undiagnosed achalasia during induction of general anesthesia - A case report -

• Kim HJ
• Choi YS
• Jin JH
• Lee B

• KMID: 2531702
• DOI: http://doi.org/10.17085/apm.21102

Abstract

Background
Intraoperative pulmonary aspiration is a rare but potentially fatal complication associated with various risk factors. Preoperative recognition of these risk factors can prevent aspiration events during general anesthesia or facilitate prompt corrective measures in patients experiencing this complication. Case: A 70-year-old female patient with hypertension underwent bilateral total knee arthroplasty under general anesthesia. Despite using a midnight nothing-per-oral (NPO) protocol, an unpredictable intraoperative aspiration event occurred during anesthesia induction. A detailed evaluation of the patient’s medical history and subsequent diagnostic imaging examinations indicated achalasia. She was treated for aspiration pneumonia for 2 weeks. After 2 months, rescheduled total knee arthroplasty was performed under spinal anesthesia without any complications.
Conclusions
Obtaining the patient’s medical history and assessing the risk factors are important to prevent unpredictable intraoperative pulmonary aspiration. High-risk patients should undergo adequate preoperative fasting and regional anesthesia or rapid-sequence intubation should be considered for safe induction of general anesthesia.

Keyword

Aspiration pneumonia; Esophageal achalasia; Respiratory aspiration

Figure

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  Fig. 1. Ultrasonographic gastric antrum measurement. A: antrum.

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  Fig. 2. The diagnostic images. (A) Diffuse and extensive dilatation of the esophagus with narrowing at the esophagogastric junction in chest CT. (B) Marked tortuous dilatation of mid to distal esophagus with abrupt narrowing at the gastroesophageal junction in esophagography (bird-beak sign). CT: computed tomography.

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  Fig. 3. Posteroanterior chest radiographs. (A) Preoperative image; (B) diffuse consolidation on both lungs on postoperative day 3; (C) improved consolidation at 4 weeks postoperatively.

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