Acid aspiration prophylaxis for emergency Caesarean section

Stuart, J. C.; Kan, A. F.; Rowbottom, S. J.; Yau, G.; Gin, Tony

doi:10.1111/j.1365-2044.1996.tb07782.x

Cited by 47 publications

(21 citation statements)

References 30 publications

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“…A 0.3 mol/l (8.8%) in a volume of 30 ml has pH of 8.4 and causes mean pH to increase to more than 6 for one hour. Molar solution of sodium citrate has been found to be equally effective in emergency and elective cases and with either general or regional anesthesia (Lin et al 1996, Stuart et al 1996. A rebound decrease in gastric pH below 2.5 can occur therefore sodium citrate 0.3 mol/l is recommended as a regular 2-4 hourly regimen for women in labor (Robert & Shirley, 1976).…”

Section: Sodium Citratementioning

confidence: 99%

“…Metoclopramide, the most frequently used increases the rate of gastric emptying, has an antiemetic and increases lower esophageal sphincter tone. It has been shown that in combination with other agents in obstetric patients at a dose of 10 mg intravenous (Stuart et al 1996) …”

Section: Prokineticsmentioning

confidence: 99%

“…The onset of effect after IV administration is similar to that of ranitidine and should be considered to be at least 40 minutes (Tripathi et al 1995). In the setting of emergency Cesarean section, a single intravenous dose of omeprazole 40 mg results in the same percentage of patients with the combination of pH <2.5 and volume > 25 ml as ranitidine 50 mg IV when combined with sodium citrate (Tripathi et al 1995, Stuart et al 1996.…”

Section: Proton Pump Inhibitorsmentioning

confidence: 99%

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Anesthesia for Cesarean Section

Capogna¹

2017

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Section: Sodium Citratementioning

confidence: 99%

Section: Prokineticsmentioning

confidence: 99%

Section: Proton Pump Inhibitorsmentioning

confidence: 99%

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Anesthesia for Cesarean Section

Capogna¹

2017

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“…Other interventions to reduce gastric contents volume and ⁄ or increase pH might intuitively reduce the risk and severity of pulmonary aspiration, including pre-surgery gastric tube drainage, use of postpyloric feeding tubes and use of pro-kinetic therapy, although evidence is limited and extrapolated from other populations e.g. elective surgery, critical care or obstetrics [30][31][32][33][34]. The presence of a tracheal tube cannot guarantee airway protection and in cases of intestinal obstruction, intra-operative enterostomy and drainage may be preferable to 'milking back' large volumes of fluid that may bypass a nasogastric tube.…”

Section: Management and Protection Of The Airway Including Pulmonary mentioning

confidence: 99%

The principles and conduct of anaesthesia for emergency surgery

Gray

Morris

2012

Anaesthesia

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SummaryIn this second article we examine the principles underlying delivery of the components of anaesthesia. Topics considered include anaesthetic technique, management of the airway and lung ventilation, induction and maintenance of anaesthesia, patient monitoring including the place of cardiac output devices. We summarise recent research on the management of shock and sepsis syndromes including goal directed therapy and examine some controversies around intravenous fluid therapy. Finally, we discuss intra-operative awareness and challenges during emergence including perioperative cognitive dysfunction. Choice of anaesthetic techniqueOptimal anaesthetic technique is dependent upon an individualised assessment of patient and surgical requirements. Prospective, randomised, controlled trials of rival anaesthetic techniques, e.g. the GALA trial, are rare [1]. Emergency anaesthesia lacks this evidence base and extrapolations from meta-analyses typically fail to reach clear recommendations for clinicians [2]. The nature of surgery, patient co-morbidities, and urgency will frequently decide the anaesthetic choice but clinicians should remain mindful of the options of local or regional anaesthesia and sedation in appropriate patients, especially when a 'lesser' procedure becomes feasible e.g. percutaneous drainage. Management and protection of the airway including pulmonary aspirationThe fourth National Audit Project (NAP4) of the Royal College of Anaesthetists recorded the epidemiology and management of airway complications in UK practice and is essential reading [3]. It is emphasised that 25% of emergency airway management takes place outside operating theatres and since publication, several resources and recommendations have become available [4][5][6]. In the UK, out-of-theatre tracheal intubation frequently occurs in the absence of essential staff and equipment and capnography was not used in nearly a third of cases in a large observational study [7].Both difficult laryngoscopy and difficult tracheal intubation are more common in emergency patients, often outside the theatre setting [8,9]. One American study of non-theatre emergency tracheal intubation by experienced practitioners identified difficulties in over 10%, with over 4% suffering complications [10]. Predictors of complications included multiple attempts and poor views at laryngoscopy and intubation in a ward or emergency department setting. Human factors are increasingly recognised in airway complications and an unfamiliar environment during airway management is likely to be important [3].

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“…Neutrophils are the primary mediators of lung injury following aspiration of gastric contents [14, 15]. Although risk factors for acid aspiration continue to be debated, the literature suggests that patients with a gastric pH of <2.5 and a gastric volume of at least 25 ml are at greatest risk [16]. …”

Section: Conditions Requiring Inpatient Antisecretory Therapymentioning

confidence: 99%

Potential Uses of Intravenous Proton Pump Inhibitors to Control Gastric Acid Secretion

Metz¹

2000

Digestion

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Proton pump inhibitors are the most effective agents for suppressing gastric acidity and are the preferred therapy for many acid-related conditions. While proton pump inhibitors have been accessible in intravenous formulations in several European countries, they have been available only as oral drugs in the United States. In the near future, the proton pump inhibitor pantoprazole is likely to become available in an intravenous formulation for American patients. Potential uses for intravenous proton pump inhibitors include treatment of Zollinger-Ellison syndrome and peptic ulcers complicated by bleeding or gastric outlet obstruction, as well as prevention of stress ulcers and acid-induced lung injury. These intravenous proton pump inhibitors are also likely to be beneficial to patients undergoing long-term maintenance with oral proton pump inhibitors who cannot take oral therapy for a period of time. Intravenous pantoprazole is especially distinguished in its lack of clinically relevant drug interactions, and it requires no dosage adjustment for patients with renal insufficiency or with mild to moderate hepatic dysfunction. Both omeprazole and pantoprazole are well tolerated in both oral and intravenous forms. Although further studies are needed to define their roles clearly, the availability of intravenous formulations of proton pump inhibitors will certainly assist with the treatment of gastric acid-related disorders.

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Acid aspiration prophylaxis for emergency Caesarean section

Cited by 47 publications

References 30 publications

Anesthesia for Cesarean Section

Anesthesia for Cesarean Section

The principles and conduct of anaesthesia for emergency surgery

Potential Uses of Intravenous Proton Pump Inhibitors to Control Gastric Acid Secretion

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