Tracheal intubation and the patient with a full stomach

Pulmonary aspiration of gastric contents, despite its infrequent occurrence, demands special preventive care. Decreased oesophageal sphincter function and protective airway reflexes caused by depression of consciousness, predispose patients to this severe complication. Recently developed preoperative fasting guidelines suggest shorter fasting periods, especially for liquids, providing more comfort to patients and less risk of hypoglycemia and dehydration, without increasing incidence of perioperative pulmonary aspiration. Routine use of drugs decreasing gastric acidity and volume seems to be indicated only for high risk patients. Tracheal intubation after rapid sequence induction of anesthesia is indicated for patients at risk of gastric content aspiration without suspicion of difficult intubation. Adequate indication of the technique, its judicious application and rational use of available drugs may promote excellent intubation conditions, with fast onset, early return to consciousness and spontaneous breathing should tracheal intubation fail. This review intends to discuss methods recently used to control volume and pH of the gastric content, protect the airways during the intubation maneuver and to decrease the gastroesophageal reflux.