ACID ASPIRATION PROPHYLAXIS DURING ANAESTHESIA FOR CAESAREAN SECTION: A SURVEY AMONG ANAESTHETISTS AT HYDERABAD

Authors

  • Jan Muhammad Shaikh
  • Saleem Sabbar
  • Nasir Aziz
  • Najma Bano Shaikh
  • Tauseefullah Akhund

Abstract

Background: Pulmonary aspiration of gastric contents leading to acid aspiration syndrome (AAS)is a well recognized risk factor during general anaesthesia (GA) for Caesarean section (CS). Thecross sectional observational study was conducted during July 2008 to October 2008 atDepartment of Anaesthesiology and Intensive Care, Liaquat University of Medical & HealthSciences Jamshoro, Sindh, Pakistan. The objective was to assess anaesthetic practice patterns andmeasures to prevent aspiration of acid gastric contents in full term pregnant women undergoinganaesthesia for Caesarean section. Methods: A structured questionnaire regarding practice ofanaesthesia for Caesarean section was distributed among anaesthetists working and practicing atHyderabad. Results from the completed questionnaires were transferred to a Microsoft Excelspreadsheet and the responses represented as percentages. Results: General anaesthesia waspreferred by 75.4% anaesthetists for caesarean section, 83.6% anaesthetists used rapid sequenceinduction with cricoid pressure during general anaesthesia, 29.5% respondents restricted clearfluids for 2–3 hours. Antacids were used by 90% of the anaesthetists, while about 50%anaesthetists performed extubation when patients were fully awake. Conclusion: Recommendedpractice patterns and measures to prevent aspiration of acid gastric contents during anaesthesia forcaesarean section are not observed by most of the anaesthetists working at Hyderabad.Keywords: Caesarean Section, Anaesthesia, Acid Aspiration Prophylaxis

References

Hajo S, Michaela S, Richard W, Burkard von H, Eberhard K.

Anaesthesia for Caesarean section and Acid Aspiration

Prophylaxis: A German Survey. Anesth Analg 1999;88:63–6.

David JB, Ingrid MB. Anesthesia for Obstetrics. In: Miller's

Anesthesia. 6th Edition. New York: Churchill Livingstone;

p. 2307–44.

Sinclair RCF, Luxton MC. Rapid sequence induction.

Continuing Education in Anaesthesia. Crit Care Pain

;5(2):45–8.

Catanzarite V, Willms D, Wong D, Landers C, Cousins

L, Schrimmer D. Acute respiratory distress syndrome in

pregnancy and the puerperium: causes, courses and outcome.

Obstet Gynecol 2001;97:760–4.

Simpson JY. Remarks on the alleged case of death from the

actions of Chloroform. Lancet 1848;1:175–6.

Warner MA, Warner ME, Weber JG. Clinical significance of

pulmonary aspiration during the perioperative period.

Anesthesiology 1993;78:56–62.

Hajo S, Michaela S. Acid aspiration prophylaxis and

Caesarean section. Curr Opin Anaesthesiol 2000;13:261–5.

Andrews WW, Ramin SM, Maberry MC, Shearer V, Black

S, Wallace DH. Effect of type of anaesthesia on blood loss at

elective repeat caesarean section. Am J Perinatol

;9:197–200.

Hagberg C, Ezri T, Abouleish E. Is aspiration prophylaxis

necessary before spinal anaesthesia for Cesarean section?

(Letter to Editor). Canad J Anesth 2000;47(1):95–6.

Hagberg C, Ezri T, Abouleish E. Etiology and incidence of

endotracheal intubation following anesthesia for Cesarean

section. Isr Med Assoc J 2001;3:653–6.

Cooper GM, McClure GH. Maternal deaths from anaesthesia.

An extract from Why Mothers Die 2000–2002, the

Confidential enquiries into Maternal Deaths in the United

Kingdom. Br J Anaesth 2005;94:417–23.

Shaikh JM, Memon A, Memon MA, Khan M. Post dural

puncture headache after spinal anaesthesia for Caesarean

section: A comparison of 25G Quincke, 27G Quincke and

G Whitacre spinal needles. J Ayub Med Coll

;20(3):10–3.

Choi PT,Galinski SE, Lucas S, Tamayo C, Jadad AR. PDPH

is a common complication of neraxial blockade in

parturients: A meta-analysis of obstetrical studies. Can J

Anaesth 2003;50:460–9.

Practice Guidelines for Obstetric Anesthesia. An Updated

Report by the American Society of Anesthesiologists Task

Force on Obstetric Anaesthesia. Anesthesiology

;106:843–63.

Calthorpe N, Lewis M. Acid aspiration prophylaxis in labour:

A survey of UK obstetric units. Int J Obstet Anesth

;14:300–4.

Uharcek P, Mlyncek M. Anaesthesia for Caesarean section

and acid aspiration prophylaxis: a survey of Slovak obstetric

departments. (Correspondence to Editor). Europ J

Anasthesiol 2007;24:720–32.

American Society of Anesthesiologists Task Force on

Preoperative Fasting. Practice guidelines for preoperative

fasting and the use of pharmacologic agents to reduce the risk

of pulmonary aspiration: application to healthy patients

undergoing elective procedures. Anesthesiology

;90:896–905.

Kluger MT, Short TG. Aspiration during anaesthesia: a

review of 133 cases from the Australian Anaesthetic Incident

Monitoring Study (AIMS). Anaesthesia 1999;54:19–26.

Engelhardt T, Webster NR. Pulmonary aspiration of gastric

contents in anaesthesia. Br J Anaesth 1999;83:453–60.

Mac®e AG, Magides AD, Richmond MN, Reilly CS. Gastric

emptying in pregnancy. Br J Anaesth 1991;67:54–5.

Sandhar BK, Elliott RH, Windram I, Rowbotham DJ.

Peripartum changes in gastric emptying. Anaesthesia

;47:196–8.

Wong CA, Loffredi M, Ganchiff JN, Zhao J, Wang Z, Avram

MJ. Gastric emptying of water in term pregnancy.

Anesthesiology 2002;96:1395-400.

Krzysztof MK, Laurence SR, Jonathan LB. The difficult

airway: Risk, prophylaxis and management. In: Chestnut DH

(Editor) Obstetric Anaesthesia-Principles and Practice. 3rd

Edition. Philadelphia: Elsevier Mosby; 2004. p.535–61.

Published

2009-12-01