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Aspiration Event



  • Definition: inhalation of gastric contents into the lung via passive regurgitation or active vomiting

  • Common patients:

    • "Full stomach": Not NPO, bowel obstruction, pregnant, gastroparesis, intoxicated

    • Incompetent LES: hiatal hernia, previous esophageal/gastric surgery, obese

    • Can't protect airway: ↓ LOC, residual NMB, neurologic disease


  • Signs/symptoms: Severe hypoxemia, ↑ peak insp. pressure, bronchospasm, ↑ tracheal/oropharyngeal secretions, chest retractions, dyspnea, coughing, laryngospasm, pulmonary edema

  • ↑ morbidity/mortality: pneumonia, ARDS, sepsis, barotrauma

  • CXR: infiltrates and atelectasis, but can be unremarkable


  • Avoid GA & excessive sedation if possible

    • Consider awake intubation

  • Ensure NPO status, if elective

  • Medications prior to induction:

    • Non-particulate antacide: Sodium citrate PO

    • H2 Antagonists: Ranitidine IV

    • Metoclopramide IV

  • Suction through NGT before inducing

    • Remove NGT when inducing

  • Suction on

  • Cricoid pressure



  • Suction oropharynx

  • Intubate & inflate cuff

  • Suction through ETT

  • PPV with 100% and adequate PEEP

  • Bronchoscopy to:

    • Assess level of contamination

    • Remove particulate matter

  • Cancel elective surgery & minimize emergency surgery

  • Supportive care

    • Crystalloids better than colloid, H2 blockers, intermittent pulmonary toilet

    • Consider antibiotics

  • Consider ECMO if unable to oxygenate


  • Gaba, D. M. (2015). Aspiration of Gastric Contents. In Crisis management in anesthesiology. essay, Elsevier Saunders.

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