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Write a short note on Aspiration of Gastric Contents.

General Surgery · Final Professional

Definition & Risk

Pulmonary aspiration is the entry of gastric contents into the lungs when the airway is unprotected under anaesthesia — causing a chemical pneumonitis (Mendelson’s syndrome) and/or airway obstruction. It is a risk in the ‘full stomach’ patient: emergencies, trauma, pregnancy, reflux, obstruction, diabetes and obesity.

Prevention & Management

Prevention: fasting, identifying at-risk patients, aspiration prophylaxis (H₂ blocker/PPI, sodium citrate, prokinetic), and a rapid sequence induction with cricoid pressure and a cuffed tube. If aspiration occurs: head-down/lateral tilt, suction the airway, secure the airway (intubate) and give 100% oxygen, with respiratory support (ventilation/PEEP as needed). Antibiotics only for secondary infection; steroids are not recommended.

DANGER / REMEMBER

Prevention outweighs treatment: identify the full-stomach patient and use a rapid sequence induction with cricoid pressure. If aspiration occurs, tilt head-down, suction, intubate and give oxygen; do not give routine steroids.

CLINICAL PEARL

Aspiration risk = full stomach (emergency, pregnancy, reflux, obstruction). Prevent with fasting, prophylaxis and RSI + cricoid pressure; treat with tilt, suction, intubate, oxygenate — antibiotics only for infection, no routine steroids.

Recognition & Consequences

Aspiration may be witnessed — gastric contents seen in the pharynx or the tube — or suspected when a patient develops wheeze, falling oxygen saturation and difficulty with ventilation during or after anaesthesia, sometimes with signs appearing on a chest radiograph. Its severity depends on the volume and acidity of the aspirate and on whether solid material causes obstruction, ranging from a mild, self-limiting pneumonitis to severe respiratory failure and secondary pneumonia. Because established aspiration is difficult to treat and potentially fatal, the emphasis remains firmly on prevention through fasting, identification of the at-risk patient and a rapid sequence induction, with prompt supportive treatment if it nonetheless occurs.

Prevention by fasting, RSI and cricoid pressure.

KEY POINT

Key points TO remember

Aspiration: gastric contents into lungs when airway unprotected → Mendelson’s pneumonitis/obstruction.
At risk: emergency, trauma, pregnancy, reflux, obstruction, diabetes, obesity (full stomach).
Prevent: fasting, prophylaxis (H₂/PPI, sodium citrate, prokinetic), RSI + cricoid pressure + cuffed tube.
Treat: head-down/lateral, suction, intubate, 100% O₂, support; antibiotics only if infected; no routine steroids.

EXAM TIP

Sources: Morgan & Mikhail’s Clinical Anesthesiology; Miller’s Anesthesia; Ajay Yadav’s Short Textbook of Anaesthesia.

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