Inhalation gastrique : épidémiologie et facteurs de risque

Objective

To determine the epidemiology and risk factors for gastric aspiration in a French university hospital.

Methods

Files were prospectively selected from a computer database of rare and severe complications between January 2002 et April 2007. Medical files were then analyzed according to a predetermined list of specific items.

Results

Forty patients suffered from gastric aspiration among 117 033 anaesthesias (4 medical files lost) (31/100,000 global incidence). All occurred during general anaesthesia, 83% at induction, 8% in the recovery room, half of the cases for emergent cases (15% of emergency). In emergency, the incidence of gastric aspiration increased by 4.5. Only 14 patients (39%) had a “full stomach”, 17 (47%) other risk factors and five (14%) none. A rapid induction–intubation sequence with a Sellick manoeuvre was performed in only 50% of patients with a full stomach and in 23.6% of those with other risk factors. Gastric aspiration occurred in three patients with a laryngeal mask. Aspiration was associated with clinical symptoms in 21 patients. Eleven patients developed an ARDS (5 deaths).

Discussion

The incidence of gastric aspiration was slightly higher in this series than in other published series. Rapid induction–intubation sequence with Sellick manoeuvre is not always used in patients with a full stomach. Restraining this technique only to these latter patients does not guarantee practionners to avoid the risk of gastric aspiration. There is a large need to define which patients are at higher risk of gastric aspiration by national recommendations of clinical practice.