Management of pulmonary aspiration due to undiagnosed achalasia during induction of general anesthesia - A case report -

Background: Intraoperative pulmonary aspiration is a rare but potentially fatal complication associated with various risk factors. Preoperative recognition of these risk factors can pre-vent aspiration events during general anesthesia or facilitate prompt corrective measures in patients experiencing this complication. Case: A 70-year-old female patient with hypertension underwent bilateral total knee arthroplasty under general anesthesia. Despite using a midnight nothing-per-oral (NPO) protocol, an unpredictable intraoperative aspiration event occurred during anesthesia induction. A detailed evaluation of the patient's medical history and subsequent diagnostic imaging ex-aminations indicated achalasia. She was treated for aspiration pneumonia for 2 weeks. After 2 months, rescheduled total knee arthroplasty was performed under spinal anesthesia without any complications. Conclusions: Obtaining the patient's medical history and assessing the risk factors are important to prevent unpredictable intraoperative pulmonary aspiration. High-risk patients should undergo adequate preoperative fasting and regional anesthesia or rapid-sequence intubation should be considered for safe induction of general anesthesia