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.

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