Answer:

Certain measures may help reduce the risk of perioperative aspiration. These include adequate fasting, prophylactic antiemetics, rapid sequence intubation (RSI), limited tidal volumes if bag ventilation is used, and extubation when the patient’s laryngeal reflexes have returned. Anti-acid medications can increase gastric pH; however, their use is only supported by expert opinion.

RSI involves preoxygenation followed by intubation using an induction agent and neuromuscular blockade without face-mask ventilation. There are no prospective randomized controlled trials that show whether RSI reduces the incidence of aspiration. However, RSI has been shown to decrease the time to achieve successful intubation, which may be beneficial when the risk of aspiration is high. The value of cricoid pressure during intubation remains controversial. A recent randomized trial did not demonstrate a reduction in aspiration with cricoid pressure but did note an increased intubation time when cricoid pressure was applied.

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