[Hiatal hernia and risk of aspiration in anesthesia induction]

Papers recently published in the literature have questioned whether residual gastric fluid volume at the time of induction is the most important risk factor for pulmonary aspiration. To estimate the risk, more factors than the gastric fluid volume have to be considered. Concomitant diseases such as the hiatal hernia must be considered. Pulmonary aspiration during induction of anaesthesia seems to be caused by a multifactorial process, which consists of gastric fluid volume, anaesthetic technique and concomitant disease. A fifty-year-old man was scheduled for elective cholecystectom. During induction, the patient surprisingly regurgitated and aspirated gastric fluid. Postoperatively, an additional barium-swallowing x-ray examination showed a hiatal hernia. This case report shows that patients who report heartburn in their case history should be prophylactically treated as endangered by aspiration, even when they are considered to have an empty stomach.