Pulmonary aspiration in pediatric patients during general anesthesia: Incidence and outcome

Study Objectives: To determine the incidence of outcome of; and risk factors for anesthesia-related pulmonary aspiration in the predominantly Pediatric population receiving anesthesia care. Design: Using a clinical concurrent quality assessment system we developed, we used data stored in a custom-designed computerized database to initiate a retrospective review. Statistical relationships were analyzed by Fisher's exact test and binary logistic regression with commercial available software. 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 admission (n = 12), cancellation of the surgical procedure (n = 4), and intubation, with or without ventilation (n = 15). Aspiration occurred significantly more often in patients with greater severity of underlying illness (ASA physical status III or IV) (p = 0.0015), intravenous induction (p = 0.0054), and age equal to or greater than 6.0 years and less than 11.0 years (p = 0.0029). Emergency procedures had a marginally significant increased aspiration risk (p = 0.0527). Conclusions: The overall 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. Physical status I or II). Anesthesia-related pulmonary aspiration was proven to be a rare event in this tertiary pediatric center and its consequences relatively mild. Because of the very low frequency and the lack of serious outcome after aspiration in ASA physical status I and Il pediatric patients, it appears that routine prophylactic administration of histamine blockers or propulsive drugs in healthy pediatric patients is unwarranted. (C) 1998 by Elsevier Science Inc.