Gastroesophageal Reflux Disease (GERD)

Aspiration risk - GERD raises the risk of regurgitation and aspiration; weigh it in airway planning, especially alongside other risk factors.

Rapid-sequence induction - For significant reflux or risk, consider an RSI with cricoid pressure and a secured airway rather than prolonged mask ventilation.

Aspiration prophylaxis - Consider a nonparticulate antacid, an H2 blocker, or a prokinetic where indicated, and continue the patient's acid suppression.

Airway at emergence - Aspiration risk persists at emergence — extubate awake with intact reflexes.

Positioning - Head-up positioning can reduce reflux during induction.

Gastroesophageal reflux disease is retrograde flow of gastric contents into the esophagus from an incompetent lower esophageal sphincter.

For the anesthetist its importance is singular and practical: it marks a patient at increased risk of regurgitation and pulmonary aspiration of gastric contents during induction and emergence, when airway reflexes are obtunded. Severe or symptomatic reflux, along with other risk factors (hiatal hernia, obesity, pregnancy, delayed emptying), shifts airway management toward aspiration precautions.