2024 FSA Podium and Poster Abstracts
P066: "NAVIGATING UNCHARTED TERRITORY: MANAGING PRE-EXISTING PULMONARY ASPIRATION IN A COMPLEX SURGICAL CASE - A CALL FOR STANDARDIZED PROTOCOLS"
Vignesh Sankar1; Karthik Sriganeshan, MS2; Matthew Yu, MS2; Michael Fitzpatrick, MD1; Jason Wigley, MD1; 1Mount Sinai Medical Center--Florida; 2Florida International University
This case report describes the challenging management of a 41-year-old individual with a complex psychiatric, social, and substance abuse history who presented to the hospital with abdominal pain, and was later diagnosed with a small bowel obstruction which eventually developed into a diverticular perforation requiring emergency surgery. The patient’s persistent rejection of nasogastric tube placement led to suspicion of pre-operative pulmonary aspiration. During rapid sequence induction and intubation, multiple failed attempts were encountered due to suspected bronchospasm and airway obstruction, resulting in profound desaturation. Timely interventions, including yankour and neptune suction, bronchoscopy, and placement of a nasogastric tube, successfully address the aspiration and improve the patient's condition.
Postoperatively, the patient faced complications, including MRSA-related access, aspiration pneumonia, and wound dehiscence, prolonging hospitalization. The complexity of this patient required an interdisciplinary approach involving internal medicine, General surgery, gastroenterology, psychiatry, and infectious disease consultations.
Apart from the multidisciplinary expertise that were required to care for this patient, this case highlights the absence of standardized protocols for managing pre-existing aspirations during anesthesia induction, revealing the need for clear guidelines and training in adapting to Unique patient scenarios. The discussion proposes potential improvements, such as reverse trendelenburg positioning, preoperative orogastric tube placement to suction, early use of a glidescope, and consideration of awake intubations with the assistance of nerve blockade.
This report underscores the importance of addressing the current gap in anesthesia protocols to enhance the safety and efficacy of perioperative care, especially in high-risk patients with complex medical histories. Standardized protocols are crucial to guide anesthesiologists in managing pre-existing aspirations, ensuring optimal patient outcomes.