Anaes SAQs · Critical incidents & patient safety
Vomiting on induction for bowel obstruction — RSI and the SOILED bundle
Final SAQ on pulmonary aspiration: Mendelson chemical pneumonitis versus pneumonia, the risk stack including GLP-1 agonists, classic versus modified RSI with the IRIS cricoid evidence, the SOILED event bundle, and the cancel-or-continue decision.
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Prompt
A 68-year-old with small-bowel obstruction, vomiting for two days, arrives for emergency laparotomy. At induction bilious fluid wells into the pharynx and spills past the cords before the cuff is inflated. Outline your prevention strategy for this high-risk airway, your immediate management of the aspiration event, and how you decide whether to cancel or continue.
Question
A 68-year-old with small-bowel obstruction, vomiting for two days, arrives for emergency laparotomy. At induction bilious fluid wells into the pharynx and spills past the cords before the cuff is inflated. Outline your prevention strategy for this high-risk airway, your immediate management of the aspiration event, and how you decide whether to cancel or continue[1][5].
References5ShowHide
- [1]Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia Br J Anaesth, 2011.PMID 21447488
- [2]Birenbaum A, Hajage D, Roche S, et al. Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial JAMA Surg, 2019.PMID 30347104
- [3]Sorbello M, et al. Pharmacological approach to rapid sequence induction/intubation: a contemporary perspective Curr Opin Anaesthesiol, 2025.PMID 40493782
- [4]Davies A. AANA Journal Course-GLP-1 Receptor Agonists: What CRNAs Need to Know About Their Expanding Role AANA J, 2026.PMID 42213027
- [5]Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia Am J Obstet Gynecol, 1946.PMID 20993766