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Perioperative pulmonary aspiration in infants and children
M A Warner1, M E Warner, D O Warner
1Perioperative Outcomes Group, Department of Anesthesiology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota 55905, USA. warner.mark@mayo.edu
Insights
Perioperative pulmonary aspiration in children is rare, occurring in 0.04% of anesthetics. Serious respiratory complications and deaths were infrequent, especially when symptoms did not develop within 2 hours.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Perioperative pulmonary aspiration of gastric contents in children can lead to mortality or morbidity.
- The frequency and outcomes of this event in pediatric patients require updated assessment.
Purpose of the Study:
- To determine the frequency of perioperative pulmonary aspiration in infants and children.
- To evaluate the outcomes and sequelae associated with pulmonary aspiration in this population.
Main Methods:
- Prospective identification of pulmonary aspiration cases in 56,138 pediatric patients (under 18 years) undergoing 63,180 general anesthetics.
- Study conducted across all surgical specialties from July 1985 to June 1997 at the Mayo Clinic.
Main Results:
- Pulmonary aspiration occurred in 24 patients (1:2,632 anesthetics; 0.04%).
- Emergency procedures were associated with a higher aspiration frequency (1:373) than elective procedures (1:4,544).
- Of 24 children who aspirated, 15 had no respiratory symptoms or sequelae; 5 developed complications requiring respiratory support, and 3 required mechanical ventilation >48h. No deaths occurred.
Conclusions:
- Perioperative pulmonary aspiration in children is infrequent, with low rates of serious respiratory morbidity and no associated mortality.
- Pediatric patients with clinically apparent aspiration but no symptoms within 2 hours did not experience respiratory sequelae.
Background:
Pulmonary aspiration of gastric contents during the perioperative period in infants and children may be associated with postoperative mortality or pulmonary morbidity. There has not been a recent determination of the frequency of this event and its outcomes in infants and children.
Methods:
The authors prospectively identified all cases of pulmonary aspiration of gastric contents during the perioperative courses of 56,138 consecutive patients younger than 18 yr of age who underwent 63,180 general anesthetics for procedures performed in all surgical specialties from July 1985 through June 1997 at the Mayo Clinic.
Results:
Pulmonary aspiration occurred in 24 patients (1: 2,632 anesthetics; 0.04%). Children undergoing emergency procedures had a greater frequency of pulmonary aspiration compared to those undergoing elective procedures (1:373 vs. 1:4,544, P < 0.001). Fifteen of the 24 children who aspirated gastric contents did not develop respiratory symptoms within 2 h of aspiration, and none of these 15 developed pulmonary sequelae. Five of these nine children who aspirated and in whom respiratory symptoms developed within 2 h subsequently had pulmonary complications treated with respiratory support (P < 0.003). Three children were treated with mechanical ventilation for more than 48 h, but no child died of sequelae of pulmonary aspiration.
Conclusions:
In this study population, the frequency of perioperative pulmonary aspiration in children was quite low. Serious respiratory morbidity was rare, and there were no associated deaths. Infants and children with clinically apparent pulmonary aspiration in whom symptoms did not develop within 2 h did not have respiratory sequelae.
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