The preoperative evaluation and preparation of patients is important. It is prudent to confirm the patient has followed the fasting guidelines. Aspiration is linked to increased perioperative morbidity and mortality and an increased volume, acidity or particulate matter correlates with a higher risk of adverse outcomes.

The normal physiological protective mechanisms to prevent aspiration include the gastro-oesophageal junction, protective airway reflexes and upper oesophageal sphincter.

Robinson and Davidson suggest this strategy to reduce risk factors:
• Reduce gastric volume
• Avoid GA and sedation
• Reduce pH of gastric content
• Protect the airway
• Prevent regurgitation
• Careful extubation

Fasting guidelines are institution-specific. Aspiration and prevention of aspiration continue to create a challenging environment in the perioperative management of patients. Careful planning and management strategies must be in place before starting any case.

Department of Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa

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