JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Aspiration Risk Using Abdominal Imaging
Alan D. Kaye, MD, PhD, Gregory J. Bordelon, MD, James Riopelle, MD, Thea Moran, MD, James H. Diaz, MD, DrPH
Aspiration is a major cause of airway related morbidity and mortality and the number one cause of adult respiratory distress syndrome (ARDS).¹-⁴ In this regard, gastric distension, seen in a number of physiological andpathophysiological processes in the settingof anesthesia induction ismost oftenassessed utilizing clinical history. A case is reported in which the anesthesiologist evaluated an existing computed tomographic scan that identified gastric distension and high risk for potential pulmonary aspiration. Preoperative nasogastric suctioning was performed to decompress the stomach and eliminate the risks of aspiration. The preoperative CT scan may provide a better assessment of pulmonary aspiration risks from gastric distension than suspicion and clinical assessment. In many patients, these scans are readily available, but not utilizedby the anesthesiologist in the preoperative setting. In addition, the preoperative reviewof other abdominal imaging studies, suchas ultrasoundandmagnetic resonance imaging (MRI),may also provide objective confirmation of gastric distension and increased risks of intraoperative pulmonary aspiration.
INTRODUCTION
Aspiration of gastric contents is the most frequent cause of airway-related death during anesthesia.¹-² In a recent British report, aspiration was the single most common cause of fatality in anesthesia events accounting, in all its forms, for 26% of all anesthesia cases and 50% of anesthesia deaths.¹ Gastric distension is a high-risk factor for pulmonary aspiration and may be undetected preoperatively. In this case report, a patient with gastric distension was identified preoperatively by review of his diagnostic abdominal CT studies. The preoperative CT scan may provide a better assessment of pulmonary aspiration risks from gastric distension than suspicion and clinical assessment. In addition, the preoperative review of other abdominal imaging studies, such as ultrasound and magnetic resonance imaging (MRI), may also provide objective confirmation of gastric distension and risks of intraoperative pulmonary aspiration.
CASE REPORT
A 62-year-old male presented to the emergency department with a three-day history of nausea, vomiting, fever, chills, and severe abdominal pain. A preoperative CT scan confirmed a diagnosis of acute appendicitis with rupture. Although not an image from the patient presented here, Figure 1 is a noncontrast CT scan of the abdomen and pelvis axial view demonstrating a distended stomach (S = stomach). Figure 2 is a noncontrast CT scan of the abdomen and pelvis sagittal view demonstrating a distended stomach (S = stomach).
Figure 1. Noncontrast CT scan of the abdomen and pelvis, axial view, demonstrating a distended stomach (S).
98 La State Med Soc VOL 170 JULY/AUG 2018
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