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Pulmonary aspiration after fibre-endoscopy of the upper gastrointestinal tract
Abstract:
Pulmonary aspiration occurred in 16 out of 65 patients (24.6%) undergoing fibre-endoscopic examinations of the upper gastrointestinal tract under intravenous sedation, but it was rarely followed by serious complications. Aspiration was found to occur under sedation with diazepam alone, diazepam with atropine, and with chlormethiazole. The most important factors contributing to aspiration are the local pharyngeal anaesthesia and the mechanical interference of the fibrescope with laryngeal closure and swallowing. The patient is also at risk of aspiration after completion of the procedure and should remain recumbent until the local anaesthesia has worn off.
Insights
Pulmonary aspiration is common during upper gastrointestinal endoscopy under sedation but rarely causes serious issues. Patients remain at risk post-procedure until local anesthesia wears off.
Area of Science:
- Gastroenterology
- Pulmonology
- Anesthesiology
Background:
- Upper gastrointestinal endoscopy is a common diagnostic procedure.
- Intravenous sedation is frequently used to enhance patient comfort during endoscopy.
- Pulmonary aspiration is a potential risk associated with endoscopic procedures.
Purpose of the Study:
- To investigate the incidence and potential complications of pulmonary aspiration during fibre-endoscopic upper gastrointestinal examinations under intravenous sedation.
- To identify factors contributing to aspiration during these procedures.
Main Methods:
- Retrospective analysis of 65 patients undergoing fibre-endoscopic upper gastrointestinal examinations.
- Intravenous sedation administered using diazepam alone, diazepam with atropine, or chlormethiazole.
- Monitoring for and documenting pulmonary aspiration events and subsequent complications.
Main Results:
- Pulmonary aspiration occurred in 16 out of 65 patients (24.6%).
- Aspiration events were associated with various sedation regimens, including diazepam and chlormethiazole.
- Local pharyngeal anesthesia and mechanical interference from the fibrescope were identified as key contributing factors.
- Serious complications following aspiration were rare.
Conclusions:
- Pulmonary aspiration is a frequent occurrence during sedated upper gastrointestinal endoscopy.
- While aspiration is common, it rarely leads to severe complications.
- Risk factors include local anesthesia and scope manipulation; patients should remain recumbent post-procedure until anesthesia subsides.