Which of the following is an ideal method to prevent aspiration pneumonia?
Ans: a (Endotracheal tube (cuffed) Ref: Ajay Yadav, p. 97Cuffed endotracheal tube is an ideal method to prevent aspiration pneumoniaPulmonary aspiration (1 in 3000)* Most common cause of death associated with anaesthesia* Normal intragastric pressure is 5 - 7 cm of water and regurgitation is prevented by tone of lower esophageal sphincter (LES)* A pressure of > 20 cm of water is required to overcome LES tone* Predisposing factorsa) Full stomach-most important factorb) Depressed level of consciousnessc) Conditions decreasing the tone of LES* Pregnancy (Mendelson syndrome- acid aspiration in late pregnancy)* Abdominal tumours* Obesity* Hiatus hernia* Presence of nasogastric tube* Drugsd) Conditions delaying gastric emptying* Diabetes* Hypothyroidism* Narcotics* Pain* Anxiety* AnticholinergicsAtropine/ glycopyrrolateOpiodsThiopentoneSodium nitroprussideDopamineHalothaneGanglion blockersPathology:Chemical trauma to bronchial and alveolar mucosa and injury to vascular endothelium can cause exudative pneumonitis or pulmonary edema (ARDS)Note:* Selliks maneuver - If GA is to be given in full stomach it should be rapid sequence (crash) intubation while the assistant maintains the cricoid pressure.Segments of lung affected in foreign body aspiration* In supine position most commonly involved segment is apical segment of right lower lobe* In lateral position most commonly involved segment is posterior segment of upper lobe (right upper lobe in rt lateral and left upper lobe in left lateral)* In standing / sitting position aspiration most commonly occurs in posterior basal segment of right lower lobe
Endotracheal tube (cuffed)
Inhalational anesthetic
Increase the intra abdominal pressure
Full stomach
Complications Of Anaesthesia