ROUTINE PREOPERATIVE GASTRIC-EMPTYING IS SELDOM INDICATED - A STUDY OF 85,594 ANESTHETICS WITH SPECIAL FOCUS ON ASPIRATION PNEUMONIA

Background: The aim of this study was to determine the incidence and s everity of pulmonary aspiration of gastric contents during anaesthesia , to determine the short- and long-term morbidity, and to evaluate pre sent routines for preoperative gastric empyting. During the study peri od, preoperative gastric empyting was done only when intestinal obstru ction was suspected. Methods: We routinely record prospectively all pr oblems during and after anaesthesia by means of a database. Ail data f or the 5 years from 1989 to 1993, a total of 85 594 anaesthetic proced ures, were analyzed. The hospital charts were also reviewed for those patients where aspiration to the lungs had occurred. Results: Pulmonar y aspiration of gastric contents was detected in 25 cases; all occurre d in patients receiving general anaesthesia. The incidence was 4.1 tim es higher in emergency procedures than in electives. There were no asp irations in 30 199 patients receiving regional anaesthesia. The compli cation occurred in all phases of anaesthesia, but clinical morbidity w as low in most cases. Three cases showed serious morbidity immediately after the event, but recovered. Two cases showed serious long-term mo rbidity, but also recovered completely. No patients died. No cases, ex cept possibly one, might have been prevented by stricter routines for preoperative gastric emptying. Conclusion: We found a low incidence of pulmonary aspiration. When it occurs, it carries a low risk for serio us morbidity. Emergency cases for general anaesthesia are most at risk . Regional anaesthesia is considered safe. There is no evidence that p reoperative gastric emptying should be routinely done in emergency cas ts, except iii patients with suspected ileus/subileus. (C) Acta Anaest hesiologica Scandinavica 40 (1996)