Pulmonary Aspiration in the Parturient

Case Synopsis

A 32-year-old woman, gravida 2, para 1, with a full-term pregnancy, undergoes general anesthesia for emergency cesarean delivery owing to prolonged fetal bradycardia. The patient receives a rapid-sequence induction using propofol and succinylcholine. The trachea is intubated using a 3.0 MacIntosh blade, cricoid pressure, and a styletted 6.5 endotracheal tube. After cesarean delivery, the patient is extubated and transferred to the postanesthesia care unit. She is breathing spontaneously with supplemental oxygen. Vital signs include blood pressure of 110/78 mm Hg, heart rate of 96 beats per minute, and arterial oxygen saturation of 88% on 6 L of oxygen by facemask. On physical examination, the patient is noted to have bilateral wheezing, and the chest radiograph reveals a right lower lobe infiltrate.