Gastric Emptying During Lumbar Extradural Analgesia in Labour: Effect of Fentanyl Supplementation

Wright, P. M. C.; Allen, Richard; Moore, J.; Donnelly, Jeannie

doi:10.1093/bja/68.3.248

Cited by 55 publications

(19 citation statements)

References 33 publications

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“…These physiological changes are less 48 h after delivery. [78][79][80] Continuous epidural infusion of lowdose local anaesthetic with fentanyl does not appear to delay gastric emptying until the total dose of fentanyl exceeds 100 mg. 68 Gastric emptying is not delayed in either obese or nonobese parturients at term who ingest 300 ml water after an overnight fast. 75 Pregnancy does not significantly alter the rate of gastric emptying.…”

Section: Effects Of Pregnancy On Gastric Functionmentioning

confidence: 99%

Perioperative fasting in adults and children

Smith

Kranke²,

Murat³

et al. 2011

European Journal of Anaesthesiology

878

176

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This guideline aims to provide an overview of the present knowledge on aspects of perioperative fasting with assessment of the quality of the evidence. A systematic search was conducted in electronic databases to identify trials published between 1950 and late 2009 concerned with preoperative fasting, early resumption of oral intake and the effects of oral carbohydrate mixtures on gastric emptying and postoperative recovery. One study on preoperative fasting which had not been included in previous reviews and a further 13 studies published since the most recent review were identified. The searches also identified 20 potentially relevant studies of oral carbohydrates and 53 on early resumption of oral intake. Publications were classified in terms of their evidence level, scientific validity and clinical relevance. The Scottish Intercollegiate Guidelines Network scoring system for assessing level of evidence and grade of recommendations was used. The key recommendations are that adults and children should be encouraged to drink clear fluids up to 2 h before elective surgery (including caesarean section) and all but one member of the guidelines group consider that tea or coffee with milk added (up to about one fifth of the total volume) are still clear fluids. Solid food should be prohibited for 6 h before elective surgery in adults and children, although patients should not have their operation cancelled or delayed just because they are chewing gum, sucking a boiled sweet or smoking immediately prior to induction of anaesthesia. These recommendations also apply to patients with obesity, gastro-oesophageal reflux and diabetes and pregnant women not in labour. There is insufficient evidence to recommend the routine use of antacids, metoclopramide or H2-receptor antagonists before elective surgery in non-obstetric patients, but an H2-receptor antagonist should be given before elective caesarean section, with an intravenous H2-receptor antagonist given prior to emergency caesarean section, supplemented with 30 ml of 0.3 mol l(-1) sodium citrate if general anaesthesia is planned. Infants should be fed before elective surgery. Breast milk is safe up to 4 h and other milks up to 6 h. Thereafter, clear fluids should be given as in adults. The guidelines also consider the safety and possible benefits of preoperative carbohydrates and offer advice on the postoperative resumption of oral intake.

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Section: Effects Of Pregnancy On Gastric Functionmentioning

confidence: 99%

Perioperative fasting in adults and children

Smith

Kranke²,

Murat³

et al. 2011

European Journal of Anaesthesiology

878

176

View full text Add to dashboard Cite

show abstract

“…Rectal administration was chosen to eliminate the variable absorption associated with oral administration, the inevitable result not only of delayed gastric emptying and maternal emesis during labor 16 but also delayed gastric emptying when epidural analgesia contains fentanyl. 17 While rectal absorption of acetaminophen can also be variable, rectal absorption of acetaminophen in pregnancy may be improved secondary to increased pelvic blood flow. Although the effective serum doses for the treatment of pyrexia have been well studied, less is known about the use of acetaminophen prophylactically to prevent pyrexia.…”

Section: Commentmentioning

confidence: 99%

Prophylactic Acetaminophen Does Not Prevent Epidural Fever in Nulliparous Women: A Double-Blind Placebo-Controlled Trial

et al. 2004

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OBJECTIVE:Epidural analgesia is associated with a four-to five-fold increase in noninfectious maternal fever in nulliparous women. Fever prophylaxis may safely reduce both unnecessary neonatal sepsis evaluations and the potential effect of fever on the fetus. STUDY DESIGN:We performed a randomized double-blind placebo-controlled study. Immediately after epidural placement, full-term nulliparas with a temperature of <99.51F received acetaminophen 650 mg or placebo, per rectum, every 4 hours. Tympanic membrane temperatures were measured hourly. Our power to detect an effect of acetaminophen treatment on maternal temperature over time was 90%. RESULTS:In all, 21 subjects were randomized to each arm. Treatment with acetaminophen did not impact maternal temperature curves. Fever >100.41F was identical in the acetaminophen and placebo groups (23.8%, p ¼ 1.0). Neonatal surveillance blood cultures did not reveal occult infection. CONCLUSIONS:Acetaminophen prophylaxis prevented neither maternal hyperthermia nor fever secondary to epidural analgesia, suggesting that the mechanism underlying fever does not include centrally mediated perturbations of maternal thermoregulation.

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“…The authors noted that an empty stomach was not visible on ultrasound and admitted that including women with presumably empty stomachs would have yielded dramatically different results: "nearly" 30% compared with "nearly" two thirds having detectable food in the stomach (exact numbers were not reported). However, subsequent research has found that epidural opioids may delay gastric emptying (Ewah et al, 1993;Wright, Allen, Moore, & Donnelly, 1992). Whether or not epidural opioids were used in the Carp et al study (1992) is not known.…”

Section: Gastric Emptying In Labormentioning

confidence: 99%