Opioid Safety, Respiratory Compromise

Aspiration and Risks of Anesthesia

By Patricia Iyer MSN RN LNCC

(Pat is a legal nurse consultant who provides education to healthcare providers about patient safety. She can be reached at patriciaiyer@gmail.com)

I woke up from a routine colonoscopy with coughing and not being able to speak. What went wrong?

The gastroenterologist told me I started coughing during the procedure. I inhaled some saliva into my lungs.

Aspiration is the entry of food, liquid, saliva, or stomach contents into the lung. The seriousness of this event can range from minor to a chemical pneumonia to death. Food particles that block the airways can cause suffocation. The people who are at risk for aspiration include people receiving anesthesia, those on ventilators, people with drug overdoses, strokes, traumatic brain injuries, and alcohol intoxication. These individuals have decreased gag reflexes, and are therefore at risk for getting substances into their lungs.

Aspiration can occur during a choking episode or vomiting. Since the stomach contents are acidic, a chemical pneumonia occurs. Bacteria normally reside in the mouth and nose. Aspiration of saliva can lead to a bacterial pneumonia.

What can you do to prevent aspiration?

  1. Take your time chewing and swallowing. Don’t cram food into your mouth. The recommendation to chew each bite 25 times is a good one for preventing aspiration, as well as for savoring food.
  2. If you are feeding someone, don’t rapidly shovel food into his mouth.
  3. Look for signs of food remaining in the mouth after swallowing or leaking form the person’s mouth or nose. This may mean she has ineffective swallowing.
  4. Notice if someone coughs a lot or seems to choke on food. This is also a warning sign of ineffective swallowing.
  5. Listen for a wet or gurgly voice after swallowing. Food may still be in the mouth.
  6. Carefully adhere to any orders to not eat or drink after a particular time before having anesthesia.
  7. Look for signs of aspiration pneumonia: coughing, fever, fatigue, chills, chest pain, foul smelling mucous, shortness of breath, noisy breathing, feeling faint or like he is not getting enough air.
  8. Contact a healthcare provider if these symptoms are present. The sooner you get treatment, the better your chances of recovery.
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My gastroenterologist started me on Levaquin, an antibiotic. It took about a week for the coughing to disappear and my voice to return to normal. My next colonoscopy is in 5 years. My doctor and I both agreed we were glad it was not sooner.

6 thoughts on “Aspiration and Risks of Anesthesia

  1. Denise

    I had a colonoscopy yesterday and when I woke up my throat was sore and had a cough and lost my voice. Today one day later I still have the cough and my voice is still gone. What can cause this.
    I called my doctor and told him and he called in medicine for me.
    I also have pain on the right side of my throat by my ear.

    • Michael Wong

      Thank you so much for reaching out and being a reader of the PPAHS blog. PPAHS does not provide medical advice. For this, please contact your doctor.

      We can share some research – Anesthesiologists caring for patients who want deep sedation for their colonoscopy typically use a drug called propofol. Studies have shown that use of propofol ay cause coughing – http://bit.ly/2lOu85T

  2. Jeanne

    I woke up after a colonoscopy and could not talk. My whole chest rattled terrible. I was wet from my shoulder and down. They listened to my chest several times. Finally, they decided to Givs me a resting treatment. I went home and went to bed. My head and chest was filled pleim and I coughed up an enormous amount. It was white and yellow and once I saw greenish. I had no sign of a cold before the surgery. My temperature rose to 99.9 and I was shaking not able to get warm. The next day I did feel better and my voice stared coming back.

  3. Andrew Hardy

    Just before I was wheeled into the operating room for my endoscopy, I was given a shot and was told it was to keep me from aspirating the mouthpiece used to perform the endoscopy. After entering the OR, I was given another shot to sedate me. Is this a normal procedure? [edited for clarity and punctuation]

    • Michael Wong

      Thank you so much for reaching out and being a reader of the PPAHS blog. PPAHS does not provide medical advice. For this, please contact your doctor.

      However, we can share some research –

      Regarding the administration of a sedative prior to the procedure, it is standard practice at many healthcare facilities to administer sedatives during endoscopy – the purpose is to improve patient comfort and practice efficiency (https://bit.ly/2CpCYjm).

      As described by the International Foundation for Gastrointestinal Disorders, “For a routine endoscopy, sedation is often given. There are many local variations about if, how, and when sedation is given. Some centers may normally provide only local anesthesia to the throat. Usually, sedation is given by intravenous injection in the examination room immediately before the test begins.” (https://bit.ly/3fGZrqF)

      Regarding aspiration during endoscopy, according to a review of literature published in the British Journal of Anesthesia – “Pulmonary aspiration is a rare but potentially life-threatening complication of sedation, avoidance of which is the goal of preprocedural fasting guidelines” (https://bit.ly/2WCfkam).

      Recently published guidelines from the American Society for Gastrointestinal Endoscopy discuss the goal of preprocedural fasting – “Because of risks of aspiration with blunting of airway-protective reflexes, patients undergoing sedation should be asked to fast for a specific time period. There is no practice standard for pre-procedural fasting that has been universally accepted. The ASA guidelines indicate that patients should not drink fluids or eat solid foods for a sufficient period of time to allow for gastric emptying before the procedure. Specifically, these guidelines state that patients should fast a minimum of 2 hours after ingestion of clear liquids and 6 hours after ingestion of light meals before sedation is administered. In situations where gastric emptying is impaired or in emergent situations, the potential for pulmonary aspiration of gastric contents must be considered …” (https://bit.ly/2WxjvUT)

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