A comparison of omeprazole and ranitidine for prophylaxis against aspiration pneumonitis in emergency Caesarean section

Yau, G.; Kan, A. F.; Gin, Tony; Oh, T. E.

doi:10.1111/j.1365-2044.1992.tb02002.x

Cited by 41 publications

(17 citation statements)

References 15 publications

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“…12,14 Only one study to date has compared ranitidine and omeprazole in labour. 15 This study concluded that although omeprazole has been shown to be more effective immediately before emergency caesarean section, this was not the case in labour where the gastric pH was lower in patients receiving omeprazole and sodium citrate (pH 5.67) compared to ranitidine and sodium citrate (pH 6.16). Although the results are statistically significant they are not clinically significant.…”

Section: Discussionmentioning

confidence: 90%

Acid aspiration prophylaxis in labour: a survey of UK obstetric units

Calthorpe

Lewis

2005

International Journal of Obstetric Anesthesia

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Section: Discussionmentioning

confidence: 90%

Acid aspiration prophylaxis in labour: a survey of UK obstetric units

Calthorpe

Lewis

2005

International Journal of Obstetric Anesthesia

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“…Of the 23 studies that were identified relating to the reduction of aspiration pneumonitis, 22 were included involving 2658 women (Dewan 1985; Elhakim 2005; Ewart 1990; Frank 1984;Hong 2004; Husemeyer 1980; Iqbal 2000; Jasson 1989; Lin 1996; Ormezzano 1990; Orr 1993; Ostheimer 1982; Ozkan 2000;Pickering 1980; Rocke 1994; Rout 1993; Tripathi 1995; Tryba 1983; Wig 1987; Yau 1992; Zoroglu 1999; Zue 1999). One study was put in section on ’Awaiting classification’ whilst we try to contact authors (Karamanlioglu 1995).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies (Ewart 1990; Lin 1996; Tripathi 1995; Yau 1992) compared H 2 antagonists with proton pump antagonists.…”

Section: Resultsmentioning

confidence: 99%

Interventions at caesarean section for reducing the risk of aspiration pneumonitis

Paranjothy¹,

Griffiths²,

Broughton³

et al. 2010

Cochrane Database of Systematic Reviews

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Background Aspiration pneumonitis is a syndrome resulting from the inhalation of gastric contents. The incidence in obstetric anaesthesia has fallen, largely due to improved anaesthetic techniques and the increased use of regional anaesthesia at caesarean section. However, aspiration pneumonitis is still a cause of maternal morbidity and mortality, and it is important to use effective prophylaxis. Objectives To determine whether interventions given prior to caesarean section reduce the risk of aspiration pneumonitis in women with an uncomplicated pregnancy. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (April 2009). Selection criteria Randomised controlled trials were included. Quasi-randomised trials were excluded. Data collection and analysis Authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. Main results Twenty-two studies, involving 2658 women, are included, all having a caesarean section under general anaesthesia. The studies covered a number of comparisons, but were mostly small and of unclear or poor quality. When compared to no treatment or placebo, there was a significant reduction in the risk of intragastric pH < 2.5 with antacids (risk ratio (RR) 0.17, 95% confidence interval (CI) 0.09 to 0.32, two studies, 108 women), H2 antagonists (RR 0.09, 95% CI 0.05 to 0.18, two studies, 170 women) and proton pump antagonists (RR 0.26, 95% CI 0.14 to 0.46, one study 80 women). H2 antagonists were associated with a reduced the risk of intragastric pH < 2.5 at intubation when compared with proton pump antagonists (RR 0.39, 95% CI 0.16 to 0.97, one study, 120 women), but compared with antacids the findings were unclear. The combined use of ’antacids plus H2 antagonists’ was associated with a significant reduction in the risk of intragastric pH < 2.5 at intubation when compared with placebo (RR 0.02, 95% CI 0.00 to 0.15, one study, 89 women) or compared with antacids alone (RR 0.12, 95% CI 0.02 to 0.92, one study, 119 women). Authors’ conclusions The quality of the evidence was poor, but the findings suggest that the combination of antacids plus H2 antagonists was more effective than no intervention, and superior to antacids alone in preventing low gastric pH. However, none of the studies assessed potential adverse effects or substantive clinical outcomes. These findings are relevant for all women undergoing caesarean section under general anaesthesia.

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“…RCTs have shown that sodium citrate reduces acidity without affecting gastric volume, 34 that ranitidine combined with sodium citrate reduces gastric volume and increases pH, 35 that omeprazole also reduces the risk of aspiration 36 and that omeprazole results in higher mean pH than ranitidine, although ranitidine with sodium citrate is cheaper. [37][38][39] Nausea and vomiting may be provoked by hypotension during regional anaesthesia for caesarean section. Treatment of the cause will alleviate the symptom.…”

Section: Aspects Of Anaesthesia For Caesarean Sectionmentioning

confidence: 99%