Gastric emptying may be reduced by a cephalad pylorus and a progesterone-mediated decrease in gastric motility (this is controversial, see Miller p 2206). Stoelting recommends treating all pregnant women as though they had a full stomach (RSI?), using a cuffed endotracheal tube, and administering non-particulate antacids prior to induction. Note that Hawkins’ analysis of maternal deaths found 33 deaths from aspiration during general anesthesia, as compared to 37 deaths from either “induction/intubation problems” or “inadequate ventilation” (Ref. 1). Note that these data are pre-LMA in the United States (1990 was the last year included in Hawkins’ analysis, the LMA was not available until 1991).
J L Hawkins, L M Koonin, S K Palmer, C P Gibbs Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology: 1997, 86(2);277-84