The occurrence of vomiting after induction but before the airway is secure can be catastrophic. Hunningher and Saunders reported a short algorithm for managing this emergency. The authors are from St. Barts in London.

Prior to surgery:

(1) The patient should be evaluated for risk of aspiration.

(2) All equipment for managing the airway should be readily available.

(3) Suction should be confirmed as working.


Situation: supraglottic obstruction and aspiration of gastric contents at induction of anesthesia


Immediate response:

(1) Call for help.

(2) Place the patient in a head-down tilt.

(3) Suction with a suction catheter.

(4) Apply cricoid pressure.

(5) Rapid sequence induction if not paralyzed.

(6) Administer 100% oxygen.

(7) If the patient can be intubated, then intubate and suction down the endotracheal tube prior to ventilation.

(8) If the patient cannot be intubated consider Proseal LMA or surgical airway. Suction the airway prior to ventilation.



(1) chest X-ray

(2) bronchoscopy

(3) Administer bronchodilators.

(4) Admit to the ICU.

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