Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Jan 20:(1):CD004943.
doi: 10.1002/14651858.CD004943.pub3.

Interventions at caesarean section for reducing the risk of aspiration pneumonitis

Shantini Paranjothy  1 , James D Griffiths, Hannah K Broughton, Gillian Ml Gyte, Heather C Brown, Jane Thomas
Affiliations
Meta-Analysis

Interventions at caesarean section for reducing the risk of aspiration pneumonitis

Shantini Paranjothy et al. Cochrane Database Syst Rev. .

Update in

Abstract

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 strategy: 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), H(2) 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). H(2) 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 H(2) 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 H(2) 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.

PubMed Disclaimer

Figures

<b>Figure 1</b>
Figure 1. Methodological quality summary: review authors’ judgements about each methodological quality item for each included study
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

    1. Dewan DM, Floyd HM, Thistlewood JM, Bogard TD. Sodium citrate premedication for elective cesarean section. Anesthesia and Analgesia. 1984;63:205. - PubMed

    2. *

    3. Dewan DM, Floyd HM, Thistlewood JM, Bogard TD, Spielman FJ. Sodium citrate pretreatment in elective cesarean section patients. Anesthesia and Analgesia. 1985;64:34–7. - PubMed
    1. Elhakim M, El-Megid WA, Metry A, El-hennawy A, El-Queseny K. Analgesic and antacid properties of i.m. tramadol given before caesarean section under general anaesthesia. British Journal of Anaesthesia. 2005;95(6):811–5. - PubMed
    1. Ewart MC, Yau G, Gin T, Kotur CF, Oh TE. A comparison of oral omeprazole and ranitidine as premedication for elective caesarean section; Proceedings of Spring Meeting of Obstetric Anaesthetists Association; ; London, UK. 1990; p. 33. 1990.

    2. *

    3. Ewart MC, Yau G, Gin T, Kotur CF, Oh TE. A comparison of the effects of omeprazole and ranitidine on gastric secretion in women undergoing elective caesarean section. Anaesthesia. 1990;45:527–30. - PubMed
    1. Frank M, Evans M, Flynn P, Aun C. Comparison of the prophylactic use of magnesium trisilicate mixture BPC,sodium citrate mixture or cimetidine in obstetrics. British Journal of Anaesthesia. 1984;56:355–61. - PubMed
    1. Hong JY. Effect of dextrose on preoperative gastric content and serum gastrin [abstract] Canadian Journal of Anesthesia. 2004;51(Suppl 1):A57.

References to studies excluded from this review

    1. Abboud TK, Curtis J, Earl S, Henriksen EH, Hughes SC, Levinson G, et al. Efficacy of clear antacid prophylaxis in obstetrics. Acta Anaesthesiologica Scandinavica. 1984;28:301–4. - PubMed
    1. Abouleish EI, Rashid S, Haque S, Giezentanner A, Joynton P, Chuang AZ. Ondansetron versus placebo for the control of nausea and vomiting during caesarean section under spinal anaesthesia. Anaesthesia. 1999;54:479–82. - PubMed
    1. Ackerman WE, Colclough GW, Guiler JM, Guilder DS, Akin JM. Epidural lipophilic opioids administered prophylactically for control of nausea, vomiting and pain during cesarean section; Proceedings of 19th Annual Meeting of Society for Obstetric Anesthesia and Perinatology; 1987; Halifax, Nova Scotia, Canada: May 20-23, p. 143. 1987.
    1. Ackerman WE, Juneja MM, Colclough GW, Kaczorowski DM. Epidural fentanyl significantly decreases nausea and vomiting during uterine manipulation in awake patients undergoing cesarean section. Anesthesiology. 1988;69:A679.
    1. Ackerman WE, Juneja MM, Colclough GW, Kaczorowski DM. Epidural lipophilic opioids significantly decrease nausea and emesis during uterine manipulation in awake patients undergoing cesarean section. Regional Anesthesia. 1989;14(2):23.

References to studies awaiting assessment

    1. Karamanlioglu B, Canogullari M, Arslan G, Alagol A, Sengonul O. The value of omeprazole and h2 receptor blockers in the prophylaxis of aspiration in cesarean operation [Sezaryen ameliyatlarinda omeprazol ve h2 reseptor blokerlerinin aspirasyon pnomonisi profilaksisindeki degeri] Turk Anesteziyoloji Ve Reanimasyon. 1995;23(3):338–42.

Additional references

    1. Bond VK, Stoelting MD, Gupta CD. Pulmonary aspiration syndrome after inhalation of gastric fluid containing antacids. Anesthesiology. 1979;51:452–3. - PubMed
    1. Browne D, Powell H. Update on some earlier controversies . In: Morgan B, editor. Controversies in obstetric anaesthesia. Vol. 2. Edward Arnold; London: 1993.
    1. Confidential Enquiry into Maternal Deaths . Confidential Enquiries into Maternal Deaths. Why mothers die 1997-1999: the fifth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. 5. RCOG Press; Regents Park, London: 2001.
    1. Cohen SE, Jasson J, Talafre ML, Chauvelot-Moachon L, Barrier G. Does metoclopramide decrease the volume of gastric contents in patients undergoing caesarean section? Anesthesiology. 1984;61(5):604–7. - PubMed
    1. Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. BMJ Books; London: 2001.

MeSH terms