This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Complications Of Anaesthesia, Subject name: Anaesthesia
Which of the following is an ideal method to prevent aspiration pneumonia? 
Select and explain. 
A. Endotracheal tube (cuffed), B. Inhalational anesthetic, C. Increase the intra abdominal pressure, D. Full stomach
A: Endotracheal tube (cuffed)
Answer: A: Endotracheal tube (cuffed) 
Explanation: Ans: a (Endotracheal tube (cuffed) Ref: Ajay Yadav, p. 97Cuffed endotracheal tube is an ideal method to prevent aspiration pneumoniaPulmonary aspiration (1 in 3000)* Most common cause of death associated with anaesthesia* Normal intragastric pressure is 5 - 7 cm of water and regurgitation is prevented by tone of lower esophageal sphincter (LES)* A pressure of > 20 cm of water is required to overcome LES tone* Predisposing factorsa) Full stomach-most important factorb) Depressed level of consciousnessc) Conditions decreasing the tone of LES* Pregnancy (Mendelson syndrome- acid aspiration in late pregnancy)* Abdominal tumours* Obesity* Hiatus hernia* Presence of nasogastric tube* Drugsd) Conditions delaying gastric emptying* Diabetes* Hypothyroidism* Narcotics* Pain* Anxiety* AnticholinergicsAtropine/ glycopyrrolateOpiodsThiopentoneSodium nitroprussideDopamineHalothaneGanglion blockersPathology:Chemical trauma to bronchial and alveolar mucosa and injury to vascular endothelium can cause exudative pneumonitis or pulmonary edema (ARDS)Note:* Selliks maneuver - If GA is to be given in full stomach it should be rapid sequence (crash) intubation while the assistant maintains the cricoid pressure.Segments of lung affected in foreign body aspiration* In supine position most commonly involved segment is apical segment of right lower lobe* In lateral position most commonly involved segment is posterior segment of upper lobe (right upper lobe in rt lateral and left upper lobe in left lateral)* In standing / sitting position aspiration most commonly occurs in posterior basal segment of right lower lobe