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Interventions at caesarean section for reducing the risk of aspiration pneumonitis.

Abstract：

BACKGROUND:Various interventions are used as prophylaxis for aspiration pneumonitis in obstetric anaesthesia. This review, based on a Cochrane systematic review currently being updated, examines whether interventions given before caesarean section reduce the risk of aspiration pneumonitis. METHODS:Twenty-two studies, involving 2658 women providing data in a usable format for meta-analysis were identified. RESULTS:Compared to no treatment or placebo, there was a significant reduction in the risk of intra-gastric pH <2.5 with antacids (risk ratio (RR) 0.17, 95% confidence interval (CI) 0.09-0.32), H2 antagonists (RR 0.09, 95% CI 0.05-0.18) and proton-pump antagonists (RR 0.26, 95% CI 0.14-0.46). H2 antagonists were associated with a reduced risk of intra-gastric pH <2.5 when compared with proton-pump antagonists (RR 0.39, 95% CI 0.16-0.97), but compared with antacids the findings were unclear. Combined use of antacids plus H2 antagonists was associated with a significant reduction in the risk of intra-gastric pH <2.5 when compared with placebo (RR 0.02, 95% CI 0.00-0.15) or compared with antacids alone (RR 0.12, 95% CI 0.02-0.92). CONCLUSION:The quality of evidence was weak and may not reflect a reduction in the risk of aspiration pneumonitis since none of the studies assessed substantive clinical outcomes or potential adverse effects. Further work is required to validate the suitability of surrogate markers of pH and gastric volume for clinical outcomes in the context of aspiration pneumonitis.

journal_name

Int J Obstet Anesth

journal_title

International journal of obstetric anesthesia

authors

Paranjothy S,Griffiths JD,Broughton HK,Gyte GM,Brown HC,Thomas J

doi

10.1016/j.ijoa.2010.12.006

subject

Has Abstract

pub_date

2011-04-01 00:00:00

pages

142-8

issue

2

eissn

0959-289X

issn

1532-3374

pii

S0959-289X(10)00201-3

journal_volume

20

pub_type

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