GER and regurgitation can cause esophagitis and aspiration pneumonia and can lead to esophageal stricture in extreme cases. When noted, suction of the esophagus is recommended followed by lavage with saline or tap water, with concurrent endotracheal tube protection of the airway. Diluted bicarbonate can be instilled into the esophagus to increase pH.⁴⁸ Maropitant prevents vomiting, promotes more rapid return to normal feeding, and improves the quality of recovery from anesthesia but appears to have a lesser effect on the incidence of reflux or regurgitation.⁴⁹ Metoclopramide, ranitidine, and omeprazole plus maropitant also appear to have a minimal impact on regurgitation.^50,51 GER and regurgitation was minimized when cisapride 1 mg/kg was combined with omeprazole 1 mg/kg.⁵² However, as GER and regurgitation cannot be consistently prevented, the use of gastroprotectants, such as omeprazole 1 mg/kg at least twice (evening prior and morning of anesthesia), can be considered for the neutralization GER pH in at-risk patients.⁵⁰