While it is not possible to foretell the exact outcome of an individual patient, the goal of preoperative evaluation is to predict the probability with which a given undesirable outcome may occur, given similar circumstances and to tailor clinical management to mitigate this risk.1,2  While early epidemiologic research estimated that pulmonary aspiration of gastric contents was a rare event, more recent evidence suggests that it continues to be a significant source of morbidity and mortality despite other advances in anesthesia patient safety.4–7  For example, the National Audit Project 4 study by the Royal College of Anesthetists in the United Kingdom reported that pulmonary aspiration was the single most common cause of death among airway management complications, more so than the inability to establish an airway.

In this issue of Anesthesiology, Warner...

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