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Pulmonary aspiration of gastric contents remains a risk in modern anaesthesia. Aspiration is considered to have occurred if any obvious nonrespiratory secretions are suctioned via a tracheal tube, there is chest x-ray evidence of new pathology after an incident and/or there are signs of new wheeze or crackles after an episode of regurgitation or vomiting. The risk factors include emergency cases, obesity, inadequate anaesthesia, inadequate fasting, opioid medication, lithotomy position (increased intra-abdominal pressure), gastrooesophageal reflux, hiatus hernia, tracheal tube problems, difficult intubation/airway management, gastrointestinal pathology (acute and/or chronic), anxiety, trauma, pregnancy, neurological deficit (pathology or sedation), dyspepsia, inadequate reversal, diabetes, sepsis and renal failure. The majority of cases occur with either face mask or LMA anaesthesia. This highlights the importance of adherence to starvation guidelines, risk assessment for aspiration, appropriate use of rapid sequence induction but also of checking suction before the start of each case.