In spite of the numerous advances in the prevention, recognition and management of complications associated with general anesthesia, regurgitation and aspiration of gastric contents continues as one of the more common problems. No matter how well prepared the patient is, or how long oral intake has been withheld, all surgical and obstetric patients requiring general anesthesia are subject to this risk.Although this question was addressed in this section several years ago, an update in concepts of management appears appropriate, and our contributors were requested to provide this information. Among the more recent approaches, antacid therapy, along with “rapid sequence” endotracheal intubation and cricoid pressure, are emphasized.