Mask ventilation in the period between induction and intubation has traditionally been used to confirm the ability to ventilate the patient while awaiting the onset of adequate neuromuscular blockade.

However, recent studies that have utilized gastric ultrasound to investigate aspiration risk have uncovered some concerning findings: not only is gastric insufflation extremely common in patients who are mask-ventilated, but a large percentage of patients arrive to the operating suite with significant gastric volumes despite adequate fasting.

Although these studies have identified a wide variety of risk factors for aspiration, a significant number of patients who aspirate perioperatively have no known risk factors.

Given that perioperative aspiration results in intensive care unit (ICU) admission 30% of the time and is the primary cause of 50% to 63% of all airway-related deaths under anesthesia, perhaps now is the time to reexamine the practice of routine mask ventilation after induction, before endotracheal intubation.

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