Pulmonary Aspiration In A Patient With “Thoracic Stomach”
Pulmonary aspiration of gastric contents in the perioperative period is a rare, but potentially catastrophic complication. Anesthesiologists routinely identify risk factors for aspiration, and take measures to reduce the incidence and severity of this complication. Pharmacological prophylaxis, NPO (nil per os, or nothing by mouth) guidelines and cricoid pressure (Selleck’s Maneuver) during induction have been utilized, although their application and efficacy are controversial. We report a case of pulmonary aspiration during the peri-operative period in a patient with severe hiatal hernia.
Case report
The patient is a 54 year-old woman (weight 110 kg, height 162 cm), with a past medical history significant for gastro-esophageal reflux disease (GERD), obesity, obstructive sleep apnea on night time CPAP and type II diabetes mellitus. Her past surgical history included Nissen fundoplication in 1998, cholecystectomy in 1999 and appendectomy in 1964. She takes omeprazole and metoclopramide daily for her GERD symptoms.
The patient was scheduled for an open reduction and internal fixation of a right ankle fracture which resulted from a fall during a syncopal episode. She was admitted to hospital on the day before surgery and underwent syncope work-up, which included a thoracic computed tomography (CT) examination (Fig 1)....