**9. Conclusion**

Patients proceeding for surgery should receive the safest anesthesia experience possible. An anesthesiologist should be prepared to manage a patient with a suspected full stomach which includes meticulous attention to airway management during induction, through emergence, and after extubation.

Pre-operative care should include adequate time for gastric emptying for non-emergent cases; administering non-particulate antacids per orally to increase gastric pH and to identify patients who may have delayed gastric emptying. Rapid sequence induction and intubation with or without cricoid pressure are recommended as per institutional guidelines. They should have a wide bore rigid suction device ready during intubation and emergence. A nasogastric tube may be placed to empty the stomach pre-induction if the patient has a suspected ileus or gastrointestinal obstruction. After surgery is completed patients should be emerged until they are fully awake with return of airway protective reflexes and then extubated. It is also recommended to empty the stomach with a nasogastric or orogastric tube prior to extubation. Postoperatively patients must be transferred to recovery and recovered in a head up position or in a lateral position.

Presence of expertise in advanced airway management is essential for awake tracheal intubation and dealing with difficult or failed airway in a patient with a full stomach. Preoperative counseling for patients with high risk for difficult airway management and pulmonary aspiration of gastric contents regarding alternative anesthesia options other than general anesthesia should be sought out.

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**Author details**

and Arunabha Karmakar

Hamad Medical Corporation, Doha, Qatar

provided the original work is properly cited.

\*Address all correspondence to: smahdi@hamad.qa

Saba Al Bassam\*, Ahmed Zaghw, Muhammad Jaffar Khan, Neethu Arun

Department of Anesthesia, Perioperative Medicine and Critical Care Medicine,

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Airway Management in Full Stomach Conditions DOI: http://dx.doi.org/10.5772/intechopen.93591*

*Airway Management in Full Stomach Conditions DOI: http://dx.doi.org/10.5772/intechopen.93591*

*Special Considerations in Human Airway Management*

**aspiration**

ventilation [61, 62].

**9. Conclusion**

**8. Perioperative negative pressure pulmonary edema versus pulmonary** 

Negative Pressure Pulmonary Edema (NPPE) also known as Post-Obstructive Pulmonary Edema (POPE), is a form of non-cardiogenic pulmonary edema that can occur perioperatively due to laryngospasm during anesthesia or following extubation in adults. NPPE is a potentially life-threatening complication following general anesthesia and is manifested by upper airway obstruction, followed by strong inspiratory effort (negative pressure). This occurs in 0.05–0.1% of cases as a life-threatening complication of general anesthesia with tracheal intubation [60]. NPPE was first hypothesized in 1927 by Morre and was described later by Oswalt in 1977. It is essential to notice the potential causes, make differential diagnosis and determine the effective treatment. NPPE usually presents with respiratory distress, hypoxia, cyanosis, frothy pink sputum, and hemoptysis. It is important to distinguish negative pressure pulmonary edema from pulmonary aspiration at the end of general anesthesia, however the diagnosis requires a strong suspicion as the presentation mimics aspiration pneumonia. In general, NPPE often demonstrates marked bilateral perihilar alveolar infiltrates on chest X-ray. Treatment modality includes supportive care such as careful post-op monitoring, reliving airway obstruction, oxygen supplementation, Bilevel Positive Airway Pressure (BIPAP) and assisted

Patients proceeding for surgery should receive the safest anesthesia experience possible. An anesthesiologist should be prepared to manage a patient with a suspected full stomach which includes meticulous attention to airway management

Pre-operative care should include adequate time for gastric emptying for non-emergent cases; administering non-particulate antacids per orally to increase gastric pH and to identify patients who may have delayed gastric emptying. Rapid sequence induction and intubation with or without cricoid pressure are recommended as per institutional guidelines. They should have a wide bore rigid suction device ready during intubation and emergence. A nasogastric tube may be placed to empty the stomach pre-induction if the patient has a suspected ileus or gastrointestinal obstruction. After surgery is completed patients should be emerged until they are fully awake with return of airway protective reflexes and then extubated. It is also recommended to empty the stomach with a nasogastric or orogastric tube prior to extubation. Postoperatively patients must be transferred to recovery and

Presence of expertise in advanced airway management is essential for awake tracheal intubation and dealing with difficult or failed airway in a patient with a full stomach. Preoperative counseling for patients with high risk for difficult airway management and pulmonary aspiration of gastric contents regarding alternative

anesthesia options other than general anesthesia should be sought out.

during induction, through emergence, and after extubation.

recovered in a head up position or in a lateral position.

**120**
