Aspiration pneumonia. Clinical outcome following documented aspiration. Arch Surg

Archives of Surgery (Impact Factor: 4.93). 02/1973; 106(1):49-52.
Source: PubMed
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    • "Most human patients are reported to be asymptomatic after aspiration of gastric contents (Mendelson 1946; Warner et al. 1993). The prognosis for uncomplicated cases of aspiration pneumonitis or AP in people is generally good (from 67 to >95% survival; Cameron et al. 1973; Ng & Smith 2001; Warner et al. 1993). Similar proportions of dogs are reported to survive AP (58–82%; Fransson et al. 2001; Alwood et al. 2006; Kogan et al. 2008a; Tart et al. 2010) with survival being lowest in dogs suffering from intracranial disease (Fransson et al. 2001). "
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    ABSTRACT: To determine the incidence of canine post-anesthetic aspiration pneumonia (AP) and to identify anesthetic agents, procedures and management factors associated with the development of AP. Multicenter, randomized, case-controlled retrospective study. Two hundred and forty dogs affected with AP and 488 unaffected control dogs. Electronic medical record databases at six Veterinary colleges were searched for dogs, coded for anesthesia or sedation and pneumonia from January 1999 to December 2009. The resultant 2158 records were hand-searched to determine eligibility for inclusion. Diagnosis of AP was made radiographically. Two unaffected control dogs were randomly selected for each affected dog, from a list of dogs that underwent sedation or anesthesia in the same time period and did not develop aspiration pneumonia. Fifty-seven factors were then evaluated for association with aspiration pneumonia. Data analysis was performed using univariate Chi-square or student t-tests, then multivariate logistic regression. Incidence of post-anesthetic AP was 0.17%, from 140,711 cases anesthetized or sedated over the 10 year period. Two anesthesia-related events were significantly associated with development of AP: regurgitation and administration of hydromorphone at induction. Administration of anticholinergics was not associated with AP. Procedures associated with increased odds of aspiration pneumonia included laparotomy, upper airway surgery, neurosurgery, thoracotomy and endoscopy. Orthopedic surgery, ophthalmologic surgery, dental procedures, MRI, CT, bronchoscopy, cystoscopy, tracheoscopy and neutering were not associated with development of AP. Three patient factors were associated with the development of AP: megaesophagus, and a history of pre-existing respiratory or neurologic disease. Sixty-nine% of dogs with two or more of the above independent predictive variables developed AP. Most anesthetic agents and procedures were not associated with the development of AP. We need to devise and evaluate strategies to protect at risk patients.
    Veterinary Anaesthesia and Analgesia 03/2014; 41(2):127-36. DOI:10.1111/vaa.12110 · 1.72 Impact Factor
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    • "A severe swallowing dysfunction may often be correlated with the risk of developing aspiration pneumonia [13], and patients suffering from aspiration pneumonia have a higher incidence of swallowing dysfunction verified on VFSE [14]. Aspiration pneumonia is a serious condition with a mortality rate of up to 62% [15]. Fall and colleagues showed that it was the most common cause of death in PD with a doubled prevalence compared with the general population (29% versus 8%) [14]. "
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    ABSTRACT: Dysphagia, which can result in aspiration pneumonia and death, is a well-known problem in patients with dementia and Parkinson's disease. There are few studies on dysphagia in patients with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), especially studies objectively documenting the type of swallowing dysfunction. The aim of this study was therefore to investigate the prevalence, and define the actual swallowing dysfunction according to a videofluoroscopic swallowing examination (VFSE) in patients with DLB and PDD. Eighty-two consecutive patients with DLB or PDD in a clinical follow-up program were asked about symptoms of dysphagia. Those experiencing dysphagia were examined with VFSE. Prevalence and type of swallowing dysfunction was recorded. Twenty-six patients (32%) reported symptoms of dysphagia such as swallowing difficulties or coughing. Twenty-four (92%) of these had a documented swallowing dysfunction on VFSE. Eighty-eight percent suffered from pharyngeal dysfunction. Almost all DLB or PDD patients with subjective signs of dysphagia had pathologic results on VFSE, the majority of pharyngeal type. This type of dysphagia has not been reported in DLB before. The results have clinical implications and highlight the importance of asking for and examining swallowing function to prevent complications such as aspiration.
    BMC Neurology 10/2013; 13(1):140. DOI:10.1186/1471-2377-13-140 · 2.04 Impact Factor
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    ABSTRACT: The objectives of this study were to assess the clinical efficacy of a new oral ranitidine liquid preparation in reducing gastric acidity and volume, to determine the degree of absorption of the drug, and to determine the duration of drug effect. Eighty preoperative children between the ages of one and six years were enrolled in each of three centres. Each subject was allocated to one of the following groups: Group A — apple juice, 5 ml · kg−1 plus placebo liquid; Group B — apple juice, 5 ml · kg−1 plus ranitidine hydrochloride 2 mg · kg−1; Group C — water, 5 ml and placebo liquid; or Group D — water, 5 ml and ranitidine liquid 2 mg · kg−1. All study agents were administered at least two hours before surgery along with a dye marker, sulfobromophthalein 1 ml (50 mg · ml−1). Following induction of anaesthesia, gastric fluid was aspirated, and analyzed for pH, volume, and sulfobro-mophthalein content (as an index of the ingested fluids). A serum sample was also drawn and analyzed for ranitidine content by high performance liquid chromatography. Groups B and D had fewer subjects with pH below 2.5 and gastric volume >0.4 ml · kg−1. The duration of reduced volume and acidity was shown to be greatest from two to four hours after drug administration. Thirty-three percent of subjects receiving oral ranitidine, 2 mg · kg−1 hydrochloride as a single dose demonstrated no measurable effect on gastric pH and volume; 28 of those subjects had adequate ranitidine serum levels. Les objectifs de cette étude clinique portent sur l’évaluation d’une nouvelle préparation liquide de ranitidine et en particulier sur sa capacité de réduction de l’acidité et du volume gastrique, son degré d’absorption et sa durée d’action. En pré-opératoire, quatre-vingts enfants âgés d’un à six ans de trois centres hospitallers font partie de l’étude. Ils sont distribués en quatre groupes: le groupe A ingère du jus de pomme 5 ml · kg−1 avec un placébo liquide; le groupe B, du jus de pomme avec de l’hydrochlorure de ranitidine 2 mg · kg−1; le groupe C, de l’eau 5 ml avec un placébo liquide; le groupe D, de l’eau avec de la ranitidine liquide 2 mg · kg−1. Toutes les préparations à l’étude sont administrées au moins deux heures avant la chirurgie avec un colorant servant de marqueur, la bromesulfonephtaléine 1 ml (50 mg · ml−1). Après l’induction de l’anesthésie, le liquide gastrique est aspiré et on en détermine le pH, le volume et le contenu en bromesulfonephtaléine. On prélève un spécimen de sérum et analyse son contenu en ranitidine par chromatographie en phase liquide à haute performance. Les groupes B et D comprennent moins de sujets avec un pH sous 2,5 et un volume gastrique plus grand que 0,4 ml · kg−1. La durée de la diminution de volume et de pH est plus importante entre la deuxième et la quatrième heure qui suivent l’administration de la drogue. Trentetrois pourcent des sujets qui ont reçu 2 mg · kg−1 de ranitidine orale ou l’hydro-chlorure en une dose ne présentent pas d’effets quantifiables sur le pH et le volume gastrique: 28 pourcent de ceuxci ont des niveaux adéquats de ranitidine sérique.
    Canadian Journal of Anaesthesia 10/1992; 39(8):791-798. DOI:10.1007/BF03008290 · 2.53 Impact Factor
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