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Chewing Gum in the Hypopharynx during Rapid Sequence Induction in a Cesearean section: A Case Report
Abstract Number: S-68
Abstract Type: Case Report/Case Series
Guidelines on preoperative fasting from the American Society of Anesthesiologists do not explicitly address gum chewing. Due to concern for increased aspiration risk from increased gastric volume and decreased pH in gastric content, preoperative gum chewing has resulted in many delayed and cancelled procedures. A recent publication addressing gastric volume and pH in patients undergoing endoscopy showed that chewing gum can result in an increase in gastric volume without change in gastric pH. Parturients have a greater risk of aspiration when undergoing general anesthesia than non-parturients and special care must be taken to minimize that risk during induction. The authors present a case of chewing gum found in the hypopharynx during rapid sequence induction for a cesarean section on a patient whose NPO status had been assessed and who had failed to disclose the use of gum.
We report a 26-year-old female who presented for scheduled cesarean section. After failed sub-arachnoid block, the anesthetic was converted to general anesthesia. During rapid sequence induction, chewing gum was identified in the hypopharynx during laryngoscopy. The gum did not obstruct the glottic opening and the endotracheal tube was carefully placed to avoid pushing the gum into the trachea. After securing the airway, attempts to remove the gum with Magill forceps were made. However, the gum was adhered to the endotracheal tube and could not be removed during the case. Bronchoscopy was performed prior to emergence to confirm the absence of gum in the patients trachea and bronchi. The patient was extubated and observed for signs of airway obstruction postoperatively.
Prior studies have shown an increased gastric volume in fasting patients after chewing gum[1,2]. However, there appears to be little research into aspiration risk for patients already at an elevated risk for aspiration, such as the parturient. In obstetric patients, NPO status guidelines have been challenged and some have suggested that chewing gum is safe. This case highlights an additional risk to chewing gum in the preoperative period and during labor.
1.GOUDRA BG, SINGH PM, CARLIN A, et al. Effect of Gum Chewing on the Volume and pH of Gastric Contents: A Prospective Randomized Study. Dig Dis Sci 2014.
2.JACONELLI T. Best evidence topic reports. BET 2: Are patients who have used chewing gum at an increased risk of aspiration during sedation? Emerg Med J 2014;31:435-6.