Are MO Patients at Increased Risk for Gastric Acid Aspiration

Obesity is an increasing epidemic. Because of the limited effect of conservative treatment for morbid obesity, more people visit bariatric surgeons. In this chapter we discuss the risk of gastric acid aspiration in morbidly obese patients. The definition of aspiration is unclear. The incidence of aspiration is <0.0004 and the overall mortality is very limited. Patients with clinically apparent aspiration who do not develop symptoms within 2 h are unlikely to have respiratory sequels. Prevention of aspiration is crucial in operating on morbidly obese patients. The anesthesiologist has to assess the patient preoperatively to predict the risk of a difficult intubation. The patient has to fast at least 6 h for solid food and 2 h for liquids. The role of aspiration prophylaxis is not yet clear; new guidelines of the European Society of Anaesthesiology do not recommend the routine use of antacids, metoclopramide or H2-receptor antagonists before elective surgery because of lack of evidence.