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.

11 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)

  4. Dedra Rainey

    I had similar experience with my colonoscopy yesterday morning. My doctor told me I started coughing and gagging to the point he had to stop the procedure. When I awoke my throat was sore and I had to constantly clear my throat all day yesterday. My friend told me my nose was severely red and running when I was still recovering. Since my doctor could not finish the procedure I had to have a barium enema so that he could review the portion of my colon that he couldn’t get to. Luckily all was negative. However today I am still having a runny nose but my throat is better. Not sure what to do for my next one in 5 years.

    • Ann

      A similar thing happened to me in 2017 after my last colonoscopy. My throat hurt for about 4 to 5 days, it hurt a lot for the first 2 days. My GI did not tell me anything after I woke up in recovery. I had to ask a nurse why my throat hurt so bad (this was my 4th colonoscopy – it never happened before). The nurse came back and said I had some aspiration into my lungs. WHY didn’t the GI doctor tell me this? For this reason, I am looking for a new GI doctor for my colonoscopy which is due in 3 months. UGH

  5. LK Brown

    I had a colonoscopy on Friday morning. When I went in my blood pressure was high and my heart rate which was normally around 60 Bpm had risen to 110. The purging process clearly did not agree with me. But when I woke up after the procedure I had an extreme sore throat. It hurt so bad! It felt like the time I had strep. I asked to be tested for Covid and strep which they did both coming back negative. I also had a stuffy nose and ear ache and could barely swallow. I had difficulty breathing. My chest hurt. It felt like I was suffocating. When I told the nurse she looked surprised. I told her that I was not like this before the procedure and asked her what had happened. She blew me off and said things went good and kept offering me crackers which I refused because I could not swallow! I asked to talk to the Dr. but was told he was with another patient and would get back with me after a few days. Later when my son came to pick me up I was told that there was a complication. The anesthesia quit working half way through the procedure and that it had become painful. I do not remember any of this. They had called him twice to get permission to either use more anesthesia and finish it or abort the procedure and reschedule. He knew I would want to finish it. All day Friday through the night I felt like I couldn’t catch my breath like I was suffocating. I felt like going to the ER. I had extreme mucous. I was drenched in sweat, nauseous, and coughing. Saturday and sunday the nausea went away and breathing got a bit easier but I still have an extreme sore throat, and runny nose. This morning Monday the sore throat and cough still persists along with some chest pain. Also I have not had a bowel movement. I was perfectly fine before the colonoscopy. I am a 67 year old Caucasian woman. I will NOT agree to having this procedure done again. The first colonoscopy I had 10 years ago was in and out no problems or side effects! Today I am going to call the clinic to try to find out what anesthesia was used. It seems I am suffering with a light case of aspiration pneumonia from the articles I’ve read. Thank you for your help. At least now I don’t feel alone in this!

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