Perioperative pulmonary aspiration in infants and children

Background Pulmonary aspiration of gastric contents during the perioperativ e period in infants and children may be associated with postoperative morta lity or pulmonary morbidity. There has not been a recent determination of t he frequency of this event and its outcomes in infants and children. Methods: The authors prospectively identified all cases of pulmonary aspira tion of gastric contents during the perioperative courses of 56,138 consecu tive patients younger than 18 yr of age who underwent 63,180 general anesth etics for procedures performed in all surgical specialties from July 1985 t hrough June 1997 at the Mayo Clinic. Results: Pulmonary aspiration occurred in 24 patients (1: 2,632 anesthetics ; 0.04%). Children undergoing emergency procedures had a greater frequency of pulmonary aspiration compared to those undergoing elective procedures (1 :373 vs. 1:4,544, P < 0.001). Fifteen of the 24 children who aspirated gast ric contents did not develop respiratory symptoms within 2 h of aspiration, and none of these 15 developed pulmonary sequelae. Five of these nine chil dren who aspirated and in whom respiratory symptoms developed within 2 h su bsequently had pulmonary complications treated with respiratory support (P < 0.003), Three children were treated with mechanical ventilation for more than 48 h, but no child died of sequelae of pulmonary aspiration. Conclusions: In this study population, the frequency of perioperative pulmo nary aspiration in children was quite low. Serious respiratory morbidity wa s rare, and there were no associated deaths. Infants and children with clin ically apparent pulmonary aspiration in whom symptoms did not develop withi n 2 h did not have respiratory sequelae.