Pulmonary aspiration is a cause of anesthesia-related morbidity and mortality, with little change in incidence over the past 20 years. Rapid sequence induction is a common procedure in obese patients, who appear to be more at risk for both pulmonary gastric aspiration and difficult airways, and is required in obese and sleep apnea syndrome patients with symptomatic gastroesophageal reflux or other predisposing conditions. In the elective obese or sleep apnea patient with no other risk factors for pulmonary aspiration, the risks and benefits of rapid sequence induction and cricoid pressure should be weighed. If rapid sequence induction is required, succinylcholine remains the neuromuscular blocking agent of choice, if there are no contraindications.