Occurrence of aspiration pneumonitis, the morbid con dition that often follows aspiration of gastric contents, has been documented for over 40 years. A number of risk factors that predispose patients to acid aspiration have been identified. The acidity of the gastric fluid and the volume of the aspirate are high-risk factors that de termine the severity of the pneumonitis. In this review I discuss those conditions that predispose patients to as piration and subsequent development of pneumonitis as well as current strategies for prevention and treatment.
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References
1.
Mendelson CLAspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol1946;52:191-199
2.
Kirsch CM, Sanders A.Aspiration pneumonia: Medical management. Otolaryngol Clin North Am1988;21(4):677-689
3.
Arms RA, Dines DE, Tinstman TCAspiration pneumonia. Chest1974;65:136-139
4.
Teabeaut JRII. Aspiration of gastric contents: an experimental study. Am J Pathol1952;28:51-60
5.
Hamelberg W. , Bosomworth PPAspiration pneumonitis: experimental studies and clinical observations. Anesth Analg1964 ;43:699-705
6.
Bosomworth PP , Hamelberg W.Etiologic and therapeutic aspects of aspiration pneumonitis: experimental study. Surg Forum1962;13:158-164
7.
Roberts RB, Shirley MAReducing the risk of acid aspiration during cesarean section. Anesth Analg1974;53:859-863
8.
James CF, Modell JH, Gibbs CP, et al. Pulmonary aspiration— effects of volume and pH in the rat. Anesth Analg1984; 63:665-668
9.
Kinni ME, Stout MMAspiration pneumonitis: predisposing conditions and prevention. J Oral Maxillofac Surg1986; 44:378-384
10.
Vaughan RW, Bauers S., Wise L.Volume and pH of gastric juice in obese patients. Anesthesiology1975;43:636-641
11.
Christensen KC, Skovsted P.Effects of general anesthetics on the pH of gastric contents in man during surgery: a survey of halothane, fluroxene, and cyclopropane anesthesia. Acta Anaesth Scand1975;19:49-55
12.
Castell DOThe lower esophageal sphincter: physiologic and clinical aspects. Ann Intern Med1975;83:390-396
13.
Manchikanti L., Colliver JA, Marrero , TC, et al. Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients. Anesth Analg1985;64:11-17
14.
Bone DK, Davis JL, Zuidema GD, et al. Aspiration pneumonia: prevention of aspiration in patients with tracheostomies. Ann Thorac Surg1974;18:30-34
15.
Spray SB, Zuidema GD, Cameron JLAspiration pneumonia: incidence of aspiration with endotracheal tubes . Am J Surg1976;131:701-706
16.
Elpern EH, Jacobs ER, Bone RCClinical studies in respiratory critical care: incidence of aspiration in tracheally intubated adults. Heart and Lung1987;16:522-531
17.
Brin MF, Younger D.Neurologic disorders and aspiration. Otolaryngol Clin North Am1988;21:691-699
18.
Hughes R., Kadlubowski M., Hurschmidt A.Treatment of acute inflammatory polyneuropathy. Ann Neurol1981; 9(suppl):125-133
19.
Millikan C.Stroke in intensive care units. Stroke1979;10: 235-237
20.
McCammon RLProphylaxis for aspiration pneumonitis. Can Anaesth Soc J1986;33(3):S47-S53
21.
Gibbs CP, Schwartz DJ, Wynne JW, et al. Antacid pulmonary aspiration in the dog. Anesthesia1979;51:380-385
22.
Taylor G.Acid pulmonary aspiration syndrome after antacids: a case report. Br J Anaesth1975;47:615-616
23.
Gibbs CP, Spohr L., Schmidt D.The effectiveness of sodium citrate as an antacid. Anesthesia1982;57:44-46.
24.
Abboud TK, Curtis J., Earl S., et al.Efficacy of clear antacid prophylaxis in obstetrics. Acta Anaesth1977;49:595-599
25.
Hester JB, Heath MLPulmonary acid aspiration syndrome: should prophylaxis be routine?Br J Anaesth1977;49:595-599
26.
Manchikanti L., Grow JB, Colliver JABictra (sodium citrate) and metoclopramide in outpatient anesthesia for prophylaxis against aspiration pneumonitis. Anesthesiology1985; 63:378-384
27.
Dewan DM, Floyd HM, Thistlewood JM, et al. Sodium citrate pretreatment in elective cesarean section patients . Anesth Analg1985;64:34-37
28.
Yildiz F., Tryba M., Kuehn K., et al. Reduction of gastric acid secretion. Anesthesia1984;39:314-318
29.
Lam AM, Grace DM, Phil D., et al. Prophylactic intravenous cimetidine reduces the risk of acid aspiration in morbidly obese patients. Anesthesiology1986;65:684-687
30.
Williams JG , Strunin L.Pre-operative intramuscular ranitidine and cimetidine. Anesthesia1985;40:242-245
31.
Duffy BL, Woodhouse PC, Schramm MD, et al. Ranitidine prophylaxis before anaesthesia in early pregnancy . Anaesth Intensive Care1984;13:29-32
32.
Aromaa U., Kalima TVRanitidine and prevention of pulmonary aspiration syndrome. Acta Anaesthesiol Scand1986; 30:10-12
33.
Manchikanti L., Colliver JA, Roush JR, et al. Evaluation of ranitidine as an oral antacid in outpatient anesthesia. So Med J1985;78:818-822
34.
Harris PW, Morison DH, Dunn GL, et al. Intramuscular cimetidine and ranitidine as prophylaxis against gastric aspiration syndrome—a randomized double blind study. Can Anaesth Soc J1984;31:599-603
35.
Husemeyer RP , Davenport HT, Rajasekapan T.Cimetidine as a single oral dose for prophylaxis against Mendelson's syndrome. Anesthesia1978 ;33:775-778
36.
Pinder RM, Brogden RN, Sawyer RR, et al. Metoclopramide. A review of its pharmacological properties and clinical use. Drugs1976;12:81-131
37.
Cohen SE, Jasson J., Talafre ML, et al. Does metoclopramide decrease the volume of gastric contents in patients undergoing cesarean section? Anesthesiology1984;61:604-607
38.
Mihaly GW, Marino AT, Webster LK, et al. High dose of antacid (Mylanta) reduces availability of ranitidine . Br Med J1982;285:998-999
39.
Gipson SL, Stovall TG, Elkins TE, et al. Pharmacologic reduction of the risk of aspiration. So Med J1986;79:1356-1358
40.
Manchikanti L., Marrero TC, Roush JR, Preanesthetic cimetidine and metoclopramide for acid aspiration prophylaxis in elective surgery. Anesthesiology1984;61:48-54
41.
Lam AM, Grace DM, Manninen PHThe effects of cimetidine and ranitidine with and without metoclopramide on gastric volume and pH in morbidly obese patients. Can Anesth Soc1986;33:773-779
42.
Manchikanti L., Colliver JA, Marrero TC, et al. Ranitidine and metoclopramide for prophylaxis of aspiration pneumonitis in elective surgery . Anesth Analg1984;63:903-910
43.
Bartlett JG, Gorbach SIThe triple threat of aspiration pneumonia. Chest1975;68:560-566
44.
Awe WC, Fletcher WS, Jacob SWThe pathophysiology of aspiration pneumonitis. Surgery1966;60:232-239
45.
Janoff A., Weissmann G., Zweifach BW, et al. Pathogenesis of experimental shock. IV. Studies on lysosomes in normal and tolerant animals subjected to lethal trauma and endotoxemia . J Exp Med1962;116:451-466
46.
Starling JR , Rudolf LE, Ferguson W., et al. Benefits of methylprednisolone in the isolated perfusion organ. Ann Surg1973 ;177:566-571
47.
Wilson JWTreatment or prevention of pulmonary cellular damage with pharmacologic doses of corticosteroid. Surg Gynecol Obstet1972 ;134:675-681
48.
Bryan-Brown CW, Baer S., Makabali G., et al. Consumable oxygen: availability of oxygen in relation to oxyhemoglobin dissociation. Crit Care Med1973;1:17-21
49.
Nicholl RM, Holland EL, Brown SS: Mendelson's syndrome: its treatment by tracheostomy and hydrocortisone . Br Med J1967;2(554):745-746
50.
Graham EC, Choy D.Corticosteroids in aspiration pneumonia. JAMA1963;184:976-977
51.
Bredenberg CEAcute respiratory distress. Surg Clin North Am1974;54:1043-1066
