Acute intraoperative aspiration is a potentially fatal complication with significant associated morbidity. Patients undergoing thoracic surgery are at increased risk for anesthesia-related aspiration, largely due to the predisposing conditions associated with this complication. Awareness of the risk factors, predisposing conditions, maneuvers to decrease risk, and immediate management options by both the thoracic surgeon and the anesthesia team is imperative to reducing risk and optimizing patient outcomes associated with acute intraoperative pulmonary aspiration. Based on the root-cause analyses that many of the aspiration events can be traced back to provider factors, having an experienced anesthesiologist present for high-risk cases is also critical. Defined as the entry of liquid or solid material into the trachea and lungs, anesthesia-related aspiration occurs when patients without sufficient laryngeal protective reflexes passively or actively regurgitate gastric contents. Pulmonary syndromes of differing severity result, ranging from mild symptoms such as hypoxia to complete respiratory failure and acute respiratory distress syndrome (ARDS), and even cardiopulmonary collapse and death. The types of pulmonary syndromes include acid-associated pneumonitis, particle-associated aspiration (e.g. airway obstruction), or bacterial infection, with subsequent development of lung abscess, exogenous lipoid pneumonia, chronic interstitial fibrosis, and Mycobacterium fortuitum pneumonia. Which of these syndromes develops depends on the composition and volume of the aspirate. This information can be published in our peer-reviewed journal with impact factors and are calculated using citations not only from research articles but also review articles (which tend to receive more citations), editorials, letters, meeting abstracts, short communications, and case reports. The inclusion of these publications provides the opportunity for editors and publishers to manipulate the ratio used to calculate the impact factor and try to increase their number rapidly. Impact factor plays a major role for the particular journal. Journal with higher impact factor is considered to be more important than other ones.
