PDF icon Download PDF
Semin Respir Crit Care Med 2024; 45(06): 659-668
DOI: 10.1055/a-2458-4450
Review Article

Aspiration after Anesthesia: Chemical versus Bacterial, Differential Diagnosis, Management, and Prevention

Denise Battaglini   *
1   Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Genova, Italy
2   Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy
,
Silvia De Rosa   *
3   Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
4   Centre for Medical Sciences, University of Trento, Trento, Italy
› Author Affiliations
Funding None.
› Further Information
   Permissions and Reprints
Preview

Abstract

Aspiration following anesthesia is a major patient issue and a difficulty for anesthesiologists. Aspiration syndromes are more common than anticipated, and the condition is frequently undetected. Clinical signs are often dictated by the characteristics of aspiration, such as the infectivity of the material, its volume, and the severity of the underlying clinical condition. Pulmonary aspiration can cause an acute or persistent inflammatory response in the lungs and upper airways that can be complicated by tracheobronchitis, aspiration pneumonia, aspiration pneumonitis, acute respiratory distress syndrome, and subsequent bacterial infection due to particle, acid, and bacteria-related processes. Aspiration during anesthesia, while relatively rare, poses significant risks for patient morbidity and mortality. Chemical and bacterial aspiration provide distinct diagnostic and management issues. Preventive strategies such as a complete preoperative risk assessment, adherence to fasting rules, proper patient positioning, and the use of protective airway devices are critical in reducing aspiration risk. In addition, drugs such as proton pump inhibitors can help lower stomach acidity and volume. Innovations in monitoring techniques, better training, and awareness activities are critical to enhancing aspiration event management. Given the importance of this entity, this narrative review sought to make an updated overview of the management of aspiration after anesthesia: chemical versus bacterial, differential diagnosis, management, and prevention.

Keywords

aspiration - anesthesia - pneumonia - bacteria - antibiotics - pulmonary aspiration

* Both the authors contributed equally.




Publication History

Article published online:
29 November 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA