Aspiration of gastric contents into the lungs during or after surgery can result in a chemical pneumonitis and/or an aspiration pneumonia. The presence of certain risk factors can help identify a patient at increased risk for aspiration. Patients at high risk may benefit from interventions to reduce the stimuli or protect the airway.


Inability to empty stomach prior to surgery:

(1) emergency surgery

(2) recent oral intake (failure to adhere to preoperative fasting)


Oropharyngeal bleeding


Esophageal disease:

(1) history of previous esophageal surgery

(2) hiatal hernia


Delayed gastric emptying:

(1) obesity (body mass index > 30)

(2) diabetes mellitus

(3) peptic ulcer disease

(4) pain, stress or recent trauma

(5) opiate administration

(6) gastric bleeding


Gastrointestinal obstruction



(1) after 16 weeks of gestation

(2) if symptoms of reflux are present

(3) in the 48 hours after delivery


Depressed CNS function:

(1) head injury

(2) decreased level of consciousness, obtunded

(3) oversedation

(4) drug overdose

(5) systemic infection and/or sepsis


Impaired airway protection:

(1) neuromuscular disease

(2) autonomic neuropathy

(3) bulbar palsy

(4) laryngeal nerve damage


Type of surgery:

(1) oropharyngeal

(2) esophageal

(3) upper abdominal


Anesthesia-related issues:

(1) difficult airway

(2) failure to take steps to protect the airway (use a cuffed endotracheal tube, etc.)

(3) history of vomiting during induction of anesthesia

(4) general anesthesia (relative to local anesthesia)


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