A Minor Hiccup: Singultus, Regurgitation, and Aspiration Under Anesthesia

  • Sonya M. SeshadriEmail author
  • Jonathan L. Benumof


Anesthesiologists may encounter a number of changes in gastrointestinal function of the anesthetized patient. The implications of these changes may include difficulty with intubation, poor operative conditions, and adverse patient outcomes such as aspiration pneumonia. The aim of this chapter is to define the pathophysiology and management of hiccups, regurgitation, and aspiration under general anesthesia. A hiccup is an episodic spasm of the diaphragm followed by vocal cord closure that is caused by activation of a reflex involving vagal afferents, the spinal cord, and the brainstem. Hiccups can be caused by a number of anesthetic and surgical factors, and the treatment of hiccups under anesthesia includes pharmacological agents and maneuvers to inhibit vagal impulses. Regurgitation under anesthesia occurs when the development of a favorable pressure gradient and the inhibition of normal physiological protective reflexes allow gastric contents to move backward in the upper gastrointestinal tract. Risk factors for regurgitation and aspiration include increased gastric volume, decreased lower esophageal sphincter tone, and loss of protective airway reflexes. Nil per os (NPO) guidelines, awake gastric emptying, and appropriate pharmacologic prophylaxis are measures for risk reduction. Witnessed or suspected aspiration under anesthesia should be treated with lateral head positioning, oral suctioning, and endotracheal intubation. Tracheal lavage, corticosteroids, and prophylactic antibiotics are not typically indicated. The differential diagnosis for hypoxemia and respiratory distress after aspiration is chemical pneumonitis, atelectasis, and aspiration pneumonia. These can be distinguished by clinical course and radiological findings.


Hiccup Singultus Regurgitation Aspiration prophylaxis Aspiration pneumonia 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologySouthern California Permanente Medical GroupSan DiegoUSA
  2. 2.Department of AnesthesiologyUniversity of California, UCSD Medical Center, UCSD School of MedicineSan DiegoUSA

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