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Pulmonary aspiration during procedural sedation: a comprehensive systematic review.
S M Green1, K P Mason2, B S Krauss3
1Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA.
British Journal of Anaesthesia
|February 11, 2017
Summary
Pulmonary aspiration during procedural sedation is rare and typically benign, especially outside of gastrointestinal endoscopy. Most patients experience full recovery, though caution is still advised.
Area of Science:
- Medical Anesthesiology
- Gastroenterology
- Patient Safety
Background:
- Pulmonary aspiration during general anesthesia is well-documented.
- Aspiration during procedural sedation remains understudied across all age groups.
Purpose of the Study:
- To systematically review and catalog instances of pulmonary aspiration during procedural sedation.
- To describe the circumstances, nature, and outcomes of aspiration events.
Main Methods:
- Comprehensive systematic review of published literature.
- Inclusion of data from 35 articles detailing aspiration occurrences.
- Analysis of events across all patient ages and procedural types.
Main Results:
- 35 articles identified 292 aspiration occurrences during gastrointestinal endoscopy, with 8 deaths.
- 34 aspiration occurrences during non-endoscopy procedures resulted in 1 death (in a moribund patient) and 31 full recoveries.
- No aspiration events were found in non-fasted patients undergoing non-endoscopy procedures.
Conclusions:
- Pulmonary aspiration during procedural sedation is rare outside of gastrointestinal endoscopy.
- Outcomes are typically benign, with full recovery being the most common result.
- While rare, aspiration events are idiosyncratic and warrant continued vigilance.
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