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Pulmonary acid aspiration syndrome: should prophylaxis be routine?

The gastric contents of three groups of patients were aspirated at the beginning and end of anaesthesia. There were 62 prepared patients, 28 emergency patients untreated and 69 prepared patients who were given 15 ml of 0.3 M sodium citrate mixture at the time of premedication. In approximately 50% of both emergency and prepared patients pH of gastric contents initially suggested the risk of developing acid aspiration syndrome, had inhalation occurred. The proportion of untreated patients in whom more than 40 ml of gastric contents was present at induction and when the tracheal tube was removed were 13% and 31% respectively. The risks were greater in those undergoing upper abdominal operations. Sodium citrate, as used in this study, was shown to be an ineffective antacid. The use of Mist. magnesium trisilicate B.P. as preoperative antacid is urged strongly.