Inability to empty stomach prior to surgery:
(1) emergency surgery
(2) recent oral intake (failure to adhere to preoperative fasting)
Oropharyngeal bleeding
Esophageal disease:
(1) history of previous esophageal surgery
(2) hiatal hernia
Delayed gastric emptying:
(1) obesity (body mass index > 30)
(2) diabetes mellitus
(3) peptic ulcer disease
(4) pain, stress or recent trauma
(5) opiate administration
(6) gastric bleeding
Gastrointestinal obstruction
Obstetrical:
(1) after 16 weeks of gestation
(2) if symptoms of reflux are present
(3) in the 48 hours after delivery
Depressed CNS function:
(1) head injury
(2) decreased level of consciousness, obtunded
(3) oversedation
(4) drug overdose
(5) systemic infection and/or sepsis
Impaired airway protection:
(1) neuromuscular disease
(2) autonomic neuropathy
(3) bulbar palsy
(4) laryngeal nerve damage
Type of surgery:
(1) oropharyngeal
(2) esophageal
(3) upper abdominal
Anesthesia-related issues:
(1) difficult airway
(2) failure to take steps to protect the airway (use a cuffed endotracheal tube, etc.)
(3) history of vomiting during induction of anesthesia
(4) general anesthesia (relative to local anesthesia)
