Routine preoperative gastric emptying is seldom indicated. A study of 85,594 anaesthetics with special focus on aspiration pneumonia.

BACKGROUND: The aim of this study was to determine the incidence and severity of pulmonary aspiration of gastric contents during anaesthesia, to determine the short- and long-term morbidity, and to evaluate present routines for preoperative gastric emptying. During the study period, preoperative gastric emptying was done only when intestinal obstruction was suspected.

METHODS: We routinely record prospectively all problems during and after anaesthesia by means of a database. All data for the 5 years from 1989 to 1993, a total of 85594 anaesthetic procedures, were analyzed. The hospital charts were also reviewed for those patients where aspiration to the lungs had occurred.

RESULTS: Pulmonary aspiration of gastric contents was detected in 25 cases; all occurred in patients receiving general anaesthesia. The incidence was 4.1 times higher in emergency procedures than in electives. There were no aspirations in 30199 patients receiving regional anaesthesia. The complication occurred in all phases of anaesthesia, but clinical morbidity was low in most cases. Three cases showed serious morbidity immediately after the event, but recovered. Two cases showed serious long-term morbidity, but also recovered completely. No patients died. No cases, except possibly one, might have been prevented by stricter routines for preoperative gastric emptying.

CONCLUSION: We found a low incidence of pulmonary aspiration. When it occurs, it carries a low risk for serious morbidity. Emergency cases for general anaesthesia are most at risk. Regional anaesthesia is considered safe. There is no evidence that preoperative gastric emptying should be routinely done in emergency cases, except in patients with suspected ileus/ subileus.