Management pulmonary aspiration (Table 1.3) 

• Initial management involves the recognition of aspiration by way of visible gastric contents in the oropharynx, or more subtle indications such as hypoxia, increased inspiratory pressure, cyanosis, tachycardia or abnormal auscultation (Rales, wheeze…) when a list of differentials must be thought through. 
  

• Once the diagnosis is suspected, the patient should be positioned head-down to limit pulmonary contamination, and suctioning performed to clear the oropharynx. 
• Oxygen (100%) must be administered, followed by immediate rapid sequence induction and securing of the airway with an endotracheal tube. At this point, tracheal suctioning should ideally precede positive pressure ventilation to avoid any aspirate being forced further down the bronchial tree. 
• Positive end expiratory pressure is useful at about 5cmH2O, and early bronchoscopy is recommended if aspiration of particulate matter is suspected to prevent distal atelectasis. 
• Symptomatic treatment of bronchospasm with bronchodilators may be necessary.
• A clinical decision between the anesthetist and surgeon must then be made on whether or not to proceed with surgery. This will depend on the underlying health of the patient, the extent of the aspiration, and urgency of the surgical procedure. 
• If stable enough for extubation, patients should be observed carefully and those that are asymptomatic 2 hours post-operatively may be discharged from the recovery area. It is suggested that those that develop a new cough/wheeze, tachycardia or tachypnea, drop their SpO2 on room air (by >10% of pre-operative value) or have new pathological changes on CXR should be further managed in an ICU (intensive care unit) setting. 
• If a patient has developed a subsequent pneumonia antibiotic should be prescribed.