Anaesthesiologic management of patients at risk of pulmonary aspiration: a Swiss consensus statement

INTRODUCTION: The perioperative management of patients at risk of pulmonary aspiration varies widely, includes several controversial aspects, and is not regulated by official guidelines. The objective of this study was to achieve peer and expert consensus in the management of patients at risk of aspiration, thereby developing guidance in Switzerland. Controversial aspects to be clarified by expert consensus were previously identified by a broad national survey. METHODS: A structured, three-phase national consensus process was conducted in Switzerland. First, the interprofessional SAFE Survey identified areas of agreement and controversy in the practice of perioperative management of patients at risk of pulmonary aspiration. Second, these recommendations were electronically reviewed, accepted, modified, or rejected by the heads of all anaesthesia departments accredited for postgraduate training in Switzerland. Third, the consolidated recommendations were presented to and formally endorsed by the Board of the Swiss Society of Anaesthesiology and Perioperative Medicine (SSAPM). RESULTS: A total of 42 out of 52 heads of anaesthesia departments contributed to the process, resulting in a response rate of 80.8%. Consensus was achieved for 17 of the 21 statements (80.9%), reflecting a successful translation of previously identified controversial topics into majority-supported recommendations. Based on the collective consensus and these findings, a national recommendation for the management of patients at risk of pulmonary aspiration was developed. DISCUSSION: The resulting national recommendations, endorsed by the official society of anaesthesiology in Switzerland, aim to standardize and improve care for this vulnerable patient group, providing a foundation for consistent clinical practice across Switzerland and other countries.