The single most important means of managing aspiration of gastric contents is in its prevention. Preoperative assessment and identification of patients at risk allows the anaesthesiologist to institute adequate preoperative fasting, administration of medication and selection of appropriate anaesthetic technique to minimize the risk of pulmonary aspiration

59 yr old male patient was posted for laproscopic /open cholecystectomy under GA. He was a diabetic on inj human actrapid as per sliding scale. He was fasted and premedicated as per standard guidelines. After preoxygenation and fentanyl 160 μg IV, anaesthesia was induced with propofol 120mg. As patient lost consciousness, bilious secretions were noted coming out of the mouth. Along with cricoid pressure, head down tilt was given. Thorough oropharyngeal suctioning was done. Instead of vecuronium, rocuronium was given for relaxation, apnoeic oxygenation done and once adequate jaw relaxation was obtained, endotracheal intubation was completed. There was no drop in the saturation from 100% during the whole episode. Thereafter the procedure was uneventful with smooth recovery. On postoperative day two, he became dyspnoeic, saturation dropped, developed crepitations and chest-xray exhibited non-homogenous opacities. He was managed conservatively and made a full recovery.

Even in an elective case, presence of any predisposing factors should compel the consultant to resort to all available preventive measures to minimize regurgitation and gastric contents

Various predisposing conditions to acid aspiration and strategies to prevent them are discussed. Even in an elective case, presence of any predisposing factors should compel the consultant to resort to all available preventive measures to minimize regurgitation and gastric contents.