[Pulmonary aspiration: epidemiology and risk factors].

OBJECTIVE

To determine the epidemiology and risk factors for gastric aspiration in a French university hospital.

METHODS

Files were prospectively selected from a computer database of rare and severe complications between January 2002 et April 2007. Medical files were then analyzed according to a predetermined list of specific items.

RESULTS

Forty patients suffered from gastric aspiration among 117 033 anaesthesias (4 medical files lost) (31/100,000 global incidence). All occurred during general anaesthesia, 83% at induction, 8% in the recovery room, half of the cases for emergent cases (15% of emergency). In emergency, the incidence of gastric aspiration increased by 4.5. Only 14 patients (39%) had a "full stomach", 17 (47%) other risk factors and five (14%) none. A rapid induction-intubation sequence with a Sellick manoeuvre was performed in only 50% of patients with a full stomach and in 23.6% of those with other risk factors. Gastric aspiration occurred in three patients with a laryngeal mask. Aspiration was associated with clinical symptoms in 21 patients. Eleven patients developed an ARDS (5 deaths).

DISCUSSION: The incidence of gastric aspiration was slightly higher in this series than in other published series. Rapid induction-intubation sequence with Sellick manoeuvre is not always used in patients with a full stomach. Restraining this technique only to these latter patients does not guarantee practitioners to avoid the risk of gastric aspiration. There is a large need to define which patients are at higher risk of gastric aspiration by national recommendations of clinical practice.