The anatomical proximity and shared structures between the respiratory and alimentary tracks, make sense -of course- for many of our evolved biological functions; but from the airway management point of view, it actually brings formidable challenges. The possibility of aspiration of gastric contents and pharyngeal secretions and blood, has been the focus of tremendous attention since the early days of our ability to instrument the airway. Is the use of SGA’s prohibitive for certain procedures or for patients that have controlled reflux disease? Or, better yet is endotracheal intubation always protective? If you are curious, read on…
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Oh, oh… what about aspiration and the use of SGA’s?
5 Responses to “Oh, oh… what about aspiration and the use of SGA’s?”
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Associate Professor of Anesthesiology at the University of Florida; I did my residency then fellowship in Cardiothoracic anesthesia, completed a Masters In Education at UF in 2012 and have been a UF/VA staff anesthesiologist since 2000. I was also the Director of the Master of Education Fellowship from the C.O.M. until the course was terminated. I am responsible for the Difficult Airway Rotation at the UF and Airway Management Services at the NFSGVHS. My interests include: 1-Airway related topics 2-Education about Airway management 3- Resident training in Airway management 4-Non-Anesthesia providers airway training and education 5-Education in general and specifically technology in education.
this reminds us that regurgitation happens with all airway approaches. what is missing is how many patienst had low ph in their airway. others have done this sort of thing with some methylene blue in the stomach and then looked oti see if it gets into the trachea. as i recall it did with uncuffed tubes and i suspect it would with the slas in people with frank refulx. it is the history of frank reflux or not that should influence the decision to use a sla and always a caution to not inflate the stomach during intital airway support.
Posted on March 3rd, 2009 at 8:00 pmthis is an interesting study that never attracted much attention. wish they had repeated it with mechanical ventilation and a little peep. maybe a uf study to be done. the spontaneous ventilation clearly predisposes to aspiration of pharyngeal secretions and also reflux from the stomach thoug the latter was not studied.
Posted on March 3rd, 2009 at 8:06 pmI think also it brings the point that is important to distinguish between regurgitation, aspiration and actually pneumonitis; although all three may present themselves, if there is overt aspiration, I guess we miss the lasttwo much more common phenomena, since we do not monitor for pH in the esophagus. Thanks for the feedback.
Posted on March 3rd, 2009 at 8:51 pmA good point that Dr. Noble makes pertains to pressure gradients between the pharynx, esophagus and trachea. Your OSA population may not have GERD/reflux, until they’re obstructing! Significant negative pressures generated in the hypopharynx may then encourage reflux. Could you justify then using an early SGA to avoid upper airway obstruction during the transition period preceding intubation, thereby minimizing this effect?
As far as the lubricant, what about non-water soluble agents? Messier, perhaps, but I’m not sure how long the water soluble agents will remain in situ.
Posted on March 3rd, 2009 at 10:36 pmFor your first point, some people actually recommend using an LMA as a bridge to extubation, for your second point I do see a future perhaps for “antibiotic coated ETT’s” similar to CVL’s… why not?
Posted on March 3rd, 2009 at 11:01 pm