Aspiration pneumonitis is the most ominous development during any anaesthetic administration. I'm sure, everyone knows that risk factors are full stomach, GERD (Gastroesophageal reflex disease), hiatal hernia, gastroparesis due to diabetes, presence of naso-gastric tube and Body mass index of 35 or more. Sodium citrate can provide buffering of gastric acid to some extent. Ranitidine 50 mg and Famotidine 20 mg are good H2 receptor blockers. Ranitidine is the drug of choice.
Proton pump inhibitors like Pantoprazole Omeprazole are not as effective as Ranitidine. Metoclopramide (Perinorm) is very useful in increasing the Lower Oesophageal Sphincter tone and as a motility stimulator. We give normally 10 mg IV. However, it can cause extra-pyramidal symptoms.
