Michael Robinson, Andrew Davidson
Continuing Education in Anaesthesia, Critical Care & Pain j 2013
Pulmonary aspiration complicates between 1 in 900 to 1 in 10 000 general anaesthetics, dependent on risk factors. All novice anaesthetists in the UK are taught to consider the risk of aspiration and to modify their anaesthetic technique accordingly. The prevention of aspiration remains a cornerstone of anaesthetic practice. The recent Royal College of Anaesthetists 4th National Audit Project (NAP4) collected data on the incidence and causes of major airway complications in the UK. Over 50% of airway-related deaths in anaesthesia were as a consequence of aspiration, outweighing the much feared can’t intubate can’t ventilate (CICV) scenario. In addition, 23% of all cases reported to NAP4 involved aspiration as either the primary or secondary event. Cases not resulting in death commonly resulted in significant morbidity and prolonged stay on intensive care.
Despite the awareness among anaesthetists of the need to minimize the risks of aspiration and advances in anaesthetic practices, NAP4 provided evidence that aspiration often occurred as a consequence of incomplete assessment of aspiration risk or a failure to modify anaesthetic technique. This review aims to highlight the key findings from NAP4 with regard to aspiration and evaluates the literature on aspiration risk assessment and decision-making.