Certified Neuroscience Registered Nurse (CNRN) Practice Exam

What is a potential risk associated with lower LES pressure in patients with GERD during emergence from anesthesia?

1. Hypotension

2. Silent aspiration

3. Pneumothorax

4. Cardiac arrest

The correct answer is: Silent aspiration

Lower esophageal sphincter (LES) pressure can lead to gastroesophageal reflux, where gastric contents are more likely to flow back into the esophagus and potentially into the airway. During emergence from anesthesia, patients may have a reduced protective reflexes and diminished consciousness, making them more vulnerable to aspiration of these gastric contents. Silent aspiration occurs when a patient inhales foreign material into the lungs without displaying the typical signs of coughing or choking, often due to impaired reflexes or decreased sensitivity during periods of altered consciousness, such as the emergence phase after anesthesia. This can result in serious complications like aspiration pneumonia or acute respiratory distress. In contrast, while hypotension, pneumothorax, and cardiac arrest are critical conditions that might arise in specific contexts during anesthesia, they are not directly linked to the physiological changes associated with lower LES pressure and the risk of aspiration. Therefore, the primary risk connected to lower LES pressure in this scenario is indeed silent aspiration, which is a significant concern in the context of patients with gastroesophageal reflux disease (GERD) emerging from anesthesia.