A 24-Year-Old Tennis Coach Was Scheduled for an Arthroscopy for Recurrent

A 24-year-old tennis coach was scheduled for an arthroscopy for recurrent knee pain.He has a family history of anesthesia and surgery complications and did his best to provide a thorough preanesthetic assessment history.He denied any history of allergies,musculoskeletal abnormalities,obstructive sleep apnea,or reflux disease.He admitted to eating a cheese steak and drinking two cans of beer the night before at 11:30 PM,but promised that he finished food and fluid intake before midnight and did not eat or drink anything else.The induction was smooth.On attempt at intubation,it was evident that total muscle relaxation had not been achieved.The circulating nurse gently restrained his arms as he began to move and gag on the laryngoscope.The patient vomited undigested stomach contents.His nasopharynx was suctioned and cleared,intubation was achieved,and a nasogastric tube was inserted and connected to suction.The patient experienced respiratory distress on extubation and was transferred to the intensive care unit (ICU) with acute respiratory distress syndrome.Based on his preanesthetic history,the incidence of aspiration could have been reduced by which measure?

A) The perioperative nurse applying cricoid pressure during induction through intubation
B) The anesthesia provider inserting a nasogastric tube to suction before induction
C) Intravenous proton pump inhibitors and an oral antacid being given 1 hour before induction
D) Intubating with a nasotracheal tube instead of per ora

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