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

Calthorpe, N.; Lewis, Michael Bevan

doi:10.1016/j.ijoa.2005.04.011

Cited by 14 publications

(5 citation statements)

References 8 publications

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“…The H 2 receptor blockers were most commonly used in our study often complemented with sodium citrate before induction. A study in 2005 looked at antacid prophylaxis in UK obstetric units 27 and reported a decrease in the routine use of acid aspiration prophylaxis in 32% of units but an increase in recommendation to use in the 'at risk' groups. We reported a large number of omissions in antacid prophylaxis in what were mainly emergency GAs and a larger proportion of our index cases receiving antacids than our controls.…”

Section: Prophylaxis Against Acid Aspirationmentioning

confidence: 99%

Failed tracheal intubation in obstetric anaesthesia: 2 yr national case–control study in the UK

Quinn

Milne

Columb

et al. 2013

British Journal of Anaesthesia

235

101

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We received 57 completed reports (100% response). The incidence using a unit-based estimation approach was one in 224 (95% confidence interval 179-281). Univariate analyses showed the index cases to be significantly older, heavier, with higher BMI, with Mallampati score recorded and score >1. Multivariate analyses showed that age, BMI, and a recorded Mallampati score were significant independent predictors of failed tracheal intubation. The classical laryngeal mask airway was the most commonly used rescue airway (39/57 cases). There was one emergency surgical airway but no deaths or hypoxic brain injuries. Gastric aspiration occurred in four (8%) index cases. Index cases were more likely to have maternal morbidities (P=0.026) and many babies in both groups were admitted to the neonatal intensive care unit: 21 (37%) vs 29 (27%) (NS). Three babies died--all in the control group.

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Section: Prophylaxis Against Acid Aspirationmentioning

confidence: 99%

Failed tracheal intubation in obstetric anaesthesia: 2 yr national case–control study in the UK

Quinn

Milne

Columb

et al. 2013

British Journal of Anaesthesia

235

101

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“…The finding of this study indicated that more than half of anesthetic providers (54%) administered aspiration prophylaxis routinely. While a survey study of UK obstetric unit on acid aspiration prophylaxis in labor found that an increase in the use of acid aspiration prophylaxis for at risk parturients to 61% [ 36 ]. This discrepancy might be due to clinical setup differences as the UK is the most developed country and they might have clinical evidence-based clinical practice guidelines.…”

Section: Discussionmentioning

confidence: 99%

The current practice of aspiration prophylaxis in obstetric anesthesia: a survey among non-physician anesthetic providers working in hospitals in Ethiopia

2021

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Background Pulmonary aspiration is one of the most important complications of obstetric anesthesia. Prevention of pulmonary aspiration is commonly performed by the application of different anesthetic maneuvers and administration of drugs. This study aimed to assess the non-physician anesthetic providers current practice of aspiration prophylaxis during anesthesia for cesarean section in Ethiopia. Methods This survey study was conducted from October 01 to November 05, 2020, on a total of 490 anesthetic providers working in hospitals in Ethiopia. A structured checklist was used to collect data from non-physician anesthetic providers. Results Four hundred and ninety (490) anesthetic providers participated in our study. The majority of the respondents (84%) were working in the public sector. Most of the cesarean delivery was done under regional anesthesia and more than half of anesthetic providers in Ethiopia administered aspiration prophylaxis routinely. Metoclopramide was the most frequently given as a prophylaxis for pulmonary aspiration. Conclusions More than half of the anesthetic providers administered aspiration prophylaxis routinely. Metoclopramide was the commonest administered aspiration prophylaxis for parturients who underwent cesarean delivery to prevent aspiration.

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“…Low-risk women are allowed a light diet. High-risk women should not eat but may have clear oral fluids, preferably isotonic drinks, together with oral administration of H 2 -receptor antagonists every 6 h [40,41]. If anaesthesia is required for delivery, an H 2 -receptor antagonist should be given intravenously if not already administered, with the aim of reducing the risk of aspiration at extubation.…”

Section: Classification Of Evidencementioning

confidence: 99%

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

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SummaryThe Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably secondgeneration) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

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

Cited by 14 publications

References 8 publications

Failed tracheal intubation in obstetric anaesthesia: 2 yr national case–control study in the UK

Failed tracheal intubation in obstetric anaesthesia: 2 yr national case–control study in the UK

The current practice of aspiration prophylaxis in obstetric anesthesia: a survey among non-physician anesthetic providers working in hospitals in Ethiopia

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

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