PULMONARY ASPIRATION IN PEDIATRIC-PATIENTS DURING GENERAL-ANESTHESIA - INCIDENCE AND OUTCOME

Study Objectives: To determine the incidence of outcome of; and risk f actors for anesthesia-related pulmonary aspiration in the predominantl y Pediatric population receiving anesthesia care. Design: Using a clin ical concurrent quality assessment system we developed, we used data s tored in a custom-designed computerized database to initiate a retrosp ective review. Statistical relationships were analyzed by Fisher's exa ct test and binary logistic regression with commercial available softw are. Setting: University-affiliated pediatric hospital. Patients: AII patients receiving anesthesia (n = 50,880) Between April 1, 1988, and March 31, 1993. Measurements and Main Results: Aspiration occurred in 52 (0.10% or 10.2 per 10, 000) of the 50, 880 general anesthesia cases . Aspirate was food or gastric contents in 25 cases (0.049% or 4.9 per 10,000), blood in 13 (0.026% or 2.6 per 10,000), and unknown material in 14 (0.0275% or 2.76 per 10,000). There were no deaths attributable to aspiration. Morbidity was confined to unanticipated hospital admis sion (n = 12), cancellation of the surgical procedure (n = 4), and int ubation, with or without ventilation (n = 15). Aspiration occurred sig nificantly more often in patients with greater severity of underlying illness (ASA physical status III or IV) (p = 0.0015), intravenous indu ction (p = 0.0054), and age equal to or greater than 6.0 years and les s than 11.0 years (p = 0.0029). Emergency procedures had a marginally significant increased aspiration risk (p = 0.0527). Conclusions: The o verall incidence of anesthesia-related aspiration in our series (0.10% ) was twice that reported in studies of adults, and four limes (0.25%) higher for those at highest risk (ASA physical status III or IV vs. P hysical status I or II). Anesthesia-related pulmonary aspiration was p roven to be a rare event in this tertiary pediatric center and its con sequences relatively mild. Because of the very low frequency and the l ack of serious outcome after aspiration in ASA physical status I and I l pediatric patients, it appears that routine prophylactic administrat ion of histamine blockers or propulsive drugs in healthy pediatric pat ients is unwarranted. (C) 1998 by Elsevier Science Inc.