Pulmonary aspiration under GA: a 13-year audit in a tertiary pediatric unit.
INTRODUCTION
Pulmonary aspiration is a known risk of general anesthesia. We aim to find out the incidence, risk factors, and outcome of pulmonary aspiration in our pediatric population.


METHODS
Since 2000, all critical incidents are reported on a standardized audit form. All cases with pulmonary aspiration being reported as a critical incident were identified and their case notes traced to look at the perioperative details.


RESULTS
From 2000 to 2013, a total of 102 425 pediatric cases were done in our hospital. Twenty-two cases were reported to have aspirated during anesthesia giving an incidence of 0.02% (1 in 4655). Majority (59.0%) of the children were between the ages of 3-12 and of ASA 1 (54.5%). None of them had any history of pulmonary aspiration. Of the 22 cases, 12 occurred during induction, three during maintenance, three during emergence, three during recovery, and one occurred preinduction. Twelve cases had intravenous induction while the rest received inhalational induction. The type of induction does not appear to affect the incidence of aspiration (OR 1.139 95% CI: 0.457-2.818 P = 0.76). Two cases were found to have a difficult airway during induction and 45.5% were emergency operations. Emergency surgeries put the patient at a higher risk of aspiration (OR 4.321 95% CI: 1.735-10.687 P = 0.001). No mortality was reported. Surgery was canceled for one patient, two had unplanned admissions, seven were admitted to high dependency unit or intensive care unit with two requiring postoperative ventilation.


CONCLUSION
The incidence of aspiration under general anesthesia in our hospital is comparable to published reports. Our audit highlights the fact that pulmonary aspiration although rare mostly occur in healthy ASA 1 and 2 children with no prior history. Emergency surgeries put the patient at a higher risk of aspiration. They occurred usually during induction, a process which tends to be variable (in technique and duration) for pediatric patients.
['Tan|Zihui|Z|', 'Lee|Shu Ying|SY|']
D000768:Anesthesia, General D002648:Child D002675:Child, Preschool D004632:Emergency Medical Services D005260:Female D006757:Hospital Units D006801:Humans D015994:Incidence D008297:Male D008485:Medical Audit D011015:Pneumonia, Aspiration D012121:Respiration, Artificial D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D063128:Tertiary Healthcare D016896:Treatment Outcome
audit anesthesia adverse events complications respiration