AANA journal course. Update for nurse anesthetists. Aspiration prophylaxis: is it time for changes in our practice?

Pulmonary aspiration of gastric contents during anesthesia is a complication that is fortunately rare, yet potentially catastrophic. Despite its infrequency, techniques geared toward preventing this serious outcome influence many of our routine practices and beliefs. Reports on large-scale clinical studies have opened new insights and questions about the effectiveness of long-standing anesthetic practices. These include conventional beliefs about preoperative fasting guidelines, acceptable gastric fluid volumes and pH, effective pharmacologic interventions, risk factors for pulmonary aspiration, and preventative anesthetic techniques such as rapid-sequence induction. This AANA Journal course outlines current knowledge as to the incidence, risk factors, and efficacy of practices geared toward preventing aspiration. It is anticipated that this review will stimulate discussions regarding possible changes in the anesthetic management of patients in individual practice settings.