Pulmonary aspiration of gastric contents in anaesthesia.

Pulmonary aspiration of gastric contents is one of the most feared complications of anaesthesia. Prevention of aspiration by identification of patients at risk, preoperative fasting, drug treatment and various anaesthetic manoeuvres are cornerstones of safe anaesthetic practice. Not surprisingly, the number of articles and case reports regarding the pulmonary consequences of gastric aspiration is vast and recommendations are often conflicting. We consider briefly the pathophysiology of this condition and examine the evidence regarding incidence, morbidity and mortality, and possible treatment options. In particular, we will consider if our fear of aspiration is exaggerated and what evidence supports the routine use of pharmacological agents to decrease gastric acidity and volume.