How common is aspiration in anaesthetic practice? Judging by the extreme care we take in establishing a secure airway, one would think it is a common and dangerous event. And, as we’re taught, especially so in emergency abdominal surgery and in obstetric patients. Here’s a run of 3000 caesarean sections using the ProSeal LMA. Not one aspiration.

The use of ProSeal laryngeal mask airway in caesarean section – experience in 3000 cases – B.K. Halaseh et al.

They report 1 regurgitation out of 3000 patients. None needed a rescue intubation.

There are similar case runs with standard LMA’s listed in the references of the above article, including this Korean study on 1076 Ceasarean sections. And here’s an overview article from Anesthesia & Analgesia on Gastroesophageal Reflux and Aspiration of Gastric Contents in Anesthetic Practice. It’s a good overview, and they comment on the relatively low incidence of gastric reflux and aspiration.

There are also several case reports of LMA’s being used successfully as a rescue device in emergency abdominal surgery and emergency caecarean sections.

Also, read this review article on Pulmonary aspiration of gastric contents in anaesthesia from BJA 1999. The conclusion is that “the incidence of pulmonary aspiration in general surgery is very small, and only slightly greater in obstetric and paediatric patients. The resulting morbidity is low and mortality is very small”. Their feeling seems to be that our fear of aspiration is exaggerated.

It’s interesting stuff, and might lead you to reach for the LMA earlier in your airway management instead of keeping at a difficult intubation.

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