Aspiration during induction of anaesthesia in patients with colon interposition

The risk of aspiration during induction of anaesthesia in patients with oesophageal disease is not well defined, and controversy exists with respect to patients who have undergone pharyngeal-gastric colon interposition. Excellent gastrooesophageal competence has been documented in many of these patients, and propulsive peristalsis has been demonstrated in interposed colonic segments, suggesting that aspiration risk is low. This report, however, describes recent anaesthetic experiences in two patients with colon interpositions and shows that these patients may have markedly redundant interposed segments that retain food or other particulate residue and, thus, present a significant risk of particulate aspiration. Awake intubation may be the best approach to avoid aspiration in these patients.