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
. 2014 Feb 5;2014(2):CD004943.
doi: 10.1002/14651858.CD004943.pub4.

Interventions at caesarean section for reducing the risk of aspiration pneumonitis

Shantini Paranjothy  1 , James D Griffiths, Hannah K Broughton, Gillian M L 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. .

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 methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013).

Selection criteria: Randomised controlled trials were included. Quasi-randomised trials were excluded.

Data collection and analysis: Review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. Fixed-effect meta-analysis was used to combine data where it was reasonable to assume that studies were estimating the same underlying treatment effect. If substantial clinical or statistical heterogeneity was detected, we used random-effects analysis to produce an overall summary.

Main results: Thirty-two studies were included in this review. However, only 22 studies, involving 2658 women, provided data for analysis. All the women in the included studies had 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 with 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.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.3
1.3. Analysis
Comparison 1 Antacids versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
1.21
1.21. Analysis
Comparison 1 Antacids versus placebo/no treatment, Outcome 21 Intragastric pH < 2.5 at extubation.
1.23
1.23. Analysis
Comparison 1 Antacids versus placebo/no treatment, Outcome 23 Gastric volume post intubation (not pre‐specified).
1.24
1.24. Analysis
Comparison 1 Antacids versus placebo/no treatment, Outcome 24 Gastric pH post intubation (not pre‐specified).
1.25
1.25. Analysis
Comparison 1 Antacids versus placebo/no treatment, Outcome 25 At risk of aspiration (not pre‐specified).
1.26
1.26. Analysis
Comparison 1 Antacids versus placebo/no treatment, Outcome 26 Gastric pH at extubation (not pre‐specified).
1.27
1.27. Analysis
Comparison 1 Antacids versus placebo/no treatment, Outcome 27 Gastric volume post intubation > 25 mL (not pre‐specified).
2.3
2.3. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
2.4
2.4. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 4 Intragastric volume > 0.4 mL/kg at intubation.
2.21
2.21. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 21 Intragastric pH < 2.5 at extubation.
2.22
2.22. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 22 Intragastric volume > 20 mL at extubation (not pre‐specified).
2.23
2.23. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 23 Gastric pH at intubation (not pre‐specified).
2.24
2.24. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 24 Gastric pH at extubation (not pre‐specified).
2.25
2.25. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 25 At risk of aspiration post intubation (not pre‐specified).
2.26
2.26. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 26 At risk of aspiration pre extubation (not pre‐specified).
2.27
2.27. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 27 Gastric volume post intubation (not pre‐specified).
2.28
2.28. Analysis
Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 28 Gastric volume pre‐extubation (not pre‐specified).
3.3
3.3. Analysis
Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
3.4
3.4. Analysis
Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 4 Intragastric volume > 0.4 mL/kg at intubation.
3.23
3.23. Analysis
Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 23 Gastric pH at intubation (not pre‐specified).
3.24
3.24. Analysis
Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 24 At risk of aspiration (not pre‐specified).
3.25
3.25. Analysis
Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 25 Gastric volume at intubation (not pre‐specified).
4.23
4.23. Analysis
Comparison 4 Prokinetic drugs versus placebo/no treatment, Outcome 23 At risk of aspiration post intubation (not pre‐specified).
4.24
4.24. Analysis
Comparison 4 Prokinetic drugs versus placebo/no treatment, Outcome 24 At risk of aspiration pre‐extubation (not pre‐specified).
5.23
5.23. Analysis
Comparison 5 Non‐pharmacological interventions versus placebo/no treatment, Outcome 23 At risk of aspiration (not pre‐specified).
6.3
6.3. Analysis
Comparison 6 Antacids + H2 antagonists versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
6.21
6.21. Analysis
Comparison 6 Antacids + H2 antagonists versus placebo/no treatment, Outcome 21 Intragastric pH < 2.5 at extubation.
6.23
6.23. Analysis
Comparison 6 Antacids + H2 antagonists versus placebo/no treatment, Outcome 23 Intragastric pH post intubation (not pre‐specified).
6.24
6.24. Analysis
Comparison 6 Antacids + H2 antagonists versus placebo/no treatment, Outcome 24 Intragastric pH at extubation (not pre‐specified).
7.3
7.3. Analysis
Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
7.23
7.23. Analysis
Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 23 Risk of aspiration (not pre‐specified).
7.24
7.24. Analysis
Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 24 Gastric pH post intubation (not pre‐specified).
7.25
7.25. Analysis
Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 25 Gastric volume post intubation (not pre‐specified).
7.26
7.26. Analysis
Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 26 Gastric volume < 25 mL after induction.
8.3
8.3. Analysis
Comparison 8 Antacids versus H2 antagonists, Outcome 3 Intragastric pH < 2.5 at intubation.
8.23
8.23. Analysis
Comparison 8 Antacids versus H2 antagonists, Outcome 23 At risk of aspiration (not pre‐specified).
8.24
8.24. Analysis
Comparison 8 Antacids versus H2 antagonists, Outcome 24 Gastric volume at intubation (not pre‐specified).
8.25
8.25. Analysis
Comparison 8 Antacids versus H2 antagonists, Outcome 25 Gastric pH at intubation (not pre‐specified).
8.26
8.26. Analysis
Comparison 8 Antacids versus H2 antagonists, Outcome 26 Gastric pH at extubation (not pre‐specified).
10.3
10.3. Analysis
Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 3 Intragastric pH < 2.5 at intubation.
10.4
10.4. Analysis
Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 4 Intragastric volume < 0.4 mL/kg at intubation.
10.23
10.23. Analysis
Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 23 At risk of aspiration (not pre‐specified).
10.24
10.24. Analysis
Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 24 Gastric pH post intubation (not pre‐specified).
10.25
10.25. Analysis
Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 25 Gastric volume post intubation (not pre‐specified).
10.26
10.26. Analysis
Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 26 Gastric pH pre extubation (not pre‐specified).
10.27
10.27. Analysis
Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 27 Gastric volume post extubation (not pre‐specified).
11.3
11.3. Analysis
Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 3 Intragastric pH < 2.5 at intubation.
11.21
11.21. Analysis
Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 21 Intragastric pH < 2.5 at extubation.
11.23
11.23. Analysis
Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 23 Post Intubation pH (not pre‐specified).
11.24
11.24. Analysis
Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 24 Pre extubation pH (not pre‐specified).
11.25
11.25. Analysis
Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 25 Post intubation gastric volume (not pre‐specified).
11.26
11.26. Analysis
Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 26 Pre‐extubation gastric volume (not pre‐specified).
11.27
11.27. Analysis
Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 27 At risk of aspiration (not pre‐specified).
13.23
13.23. Analysis
Comparison 13 Proton pump agonists + prokinetics versus proton pump agonists, Outcome 23 At risk of aspiration post intubation (not pre‐specified).
13.24
13.24. Analysis
Comparison 13 Proton pump agonists + prokinetics versus proton pump agonists, Outcome 24 At risk of aspiration pre extubation (not pre specified).
14.4
14.4. Analysis
Comparison 14 H2 antagonist versus tramadol, Outcome 4 Intragastric volume > 0.4 mL/kg at intubation.
14.5
14.5. Analysis
Comparison 14 H2 antagonist versus tramadol, Outcome 5 Nausea.
14.22
14.22. Analysis
Comparison 14 H2 antagonist versus tramadol, Outcome 22 Intragastric volume > 0.4 mL/kg at extubation.
14.23
14.23. Analysis
Comparison 14 H2 antagonist versus tramadol, Outcome 23 At risk post intubation (not pre‐specified).
14.24
14.24. Analysis
Comparison 14 H2 antagonist versus tramadol, Outcome 24 At risk pre extubation (not pre‐specified).
14.25
14.25. Analysis
Comparison 14 H2 antagonist versus tramadol, Outcome 25 Nausea 24hours post op (not pre‐specified).
15.23
15.23. Analysis
Comparison 15 Antacids + H2 antagonists versus proton pump antagonists, Outcome 23 At risk of aspiration (not pre‐specified).
16.23
16.23. Analysis
Comparison 16 Proton pump antagonist + antacid versus proton pump antagonist, Outcome 23 Risk of aspiration (not pre‐specified).
17.23
17.23. Analysis
Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 23 Intragastric pH > 2.5 post intubation (not pre‐specified).
17.24
17.24. Analysis
Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 24 Intragastric volume <0.4 mL/kg post intubation (not pre‐specified).
17.25
17.25. Analysis
Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 25 Risk of aspiration (not pre‐specified).
17.26
17.26. Analysis
Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 26 Gastric volume post intubation (not pre‐specified).
17.27
17.27. Analysis
Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 27 Gastric pH post intubation (not pre‐specified).
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Bifarini 1990 {published data only}
    1. Bifarini G, Trabalza N, Falconi S, Mala L, Favetta P. Effects on newborn of pharmacological prophylaxis for Mendelson's syndrome. Minerva Anestesiologica 1990;56:1447‐50. - PubMed
Bifarini 1992 {published data only}
    1. Bifarini G, Favetta P, Ciammiti B, Cirulli P, Sindaco F, Pasqualucci A. Pharmacological prevention of Mendelson's syndrome: controlled clinical trial. Minerva Anestesiologica 1992;58(3):95‐9. - PubMed
Bylsma‐Howell 1983 {published data only}
    1. Bylsma‐Howell M, McMorland GH, Rurak DW, McErlane B, Axelson JE. Placental transport of metoclopramide: assessment of maternal and neonatal effects. Canadian Anaesthetists Society Journal 1983;30:487‐92. - PubMed
Dewan 1985 {published data only}
    1. Dewan DM, Floyd HM, Thistlewood JM, Bogard TD. Sodium citrate premedication for elective cesarean section. Anesthesia and Analgesia 1984;63:205. - PubMed
    1. 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
Elhakim 2005 {published data only}
    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
Ewart 1990a {published data only}
    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; 1990; London, UK. 1990:33.
    1. 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
Fogarty 1992 {published data only}
    1. Fogarty DJ, Moore J. Further investigations of omeprazole in obstetric patients. International Journal of Obstetric Anesthesia 1992;1:180.
Frank 1984 {published data only}
    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
Hodgkinson 1983 {published data only}
    1. Hodgkinson R, Glassenberg R, Joyce TH, Coombs DW, Ostheimer GW, Gibbs CP. Comparison of cimetidine (Tagamet) with antacid for safety and effectiveness in reducing gastric acidity before elective cesarean section. Anesthesiology 1983;59:86‐90. - PubMed
Hong 2004 {published data only}
    1. Hong JY. Effect of dextrose on preoperative gastric content and serum gastrin [abstract]. Canadian Journal of Anesthesia 2004;51(Suppl 1):A57.
Husemeyer 1980 {published data only}
    1. Husemeyer RP, Davenport HT. Prophylaxis for Mendelson's syndrome before elective caesarean section. A comparison of cimetidine and magnesium trisilicate mixture regimens. British Journal of Obstetrics and Gynaecology 1980;87:565‐70. - PubMed
Iqbal 2000 {published data only}
    1. Iqbal MS, Ashfaque M, Akram M. Gastric fluid volume and pH: a comparison of effects of ranitidine alone with combination of ranitidine and metoclopramide in patients undergoing elective caesarean section. Annals of King Edward Medical College 2000;6(2):189‐91.
Jasson 1989 {published data only}
    1. Jasson J, Lefevre G, Talaffre ML, Legagneux F, Guerin JP, Vassilieff N, et al. Immediate pre‐anesthetic administration of sodium citrate in cesarean interventions [abstract] [Administration immediate pre‐anesthesique de citrate de sodium pour intervention cesarienne programmee]. Annales Francaises d'Anesthesie et de Reanimation 1987;6:R155.
    1. Jasson J, Lefevre G, Tallet F, Talafre ML, Legagneux F, Conseiller C. Oral sodium citrate before general anaesthesia for elective caesarean section Effects of pH and volume of gastric content [Ingestion de citrate de sodium avant l'anesthesie generale pour cesarienne programmee. Effet sur le pH et le volume du contenu gastrique]. Annales Francaises d Anesthesie et de Reanimation 1989;8:12‐8. - PubMed
Lin 1996 {published data only}
    1. Lin CJ, Huang CL, Hsu HW, Chen TL. Prophylaxis against acid aspiration in regional anesthesia for elective cesarean section: a comparison between oral single‐dose ranitidine, famotidine and omeprazole assessed with fiberoptic gastric aspiration. Acta Anaesthesiologica Sinica 1996;34(4):179‐84. - PubMed
O'Sullivan 1985 {published data only}
    1. O'Sullivan G, Sear JW, Bullingham RE, Carrie LE. The effect of magnesium trisilicate mixture, metoclopramide and ranitidine on gastric ph, volume and serum gastrin. Anaesthesia 1985;40(3):246‐53. - PubMed
Ormezzano 1990 {published data only}
    1. Ormezzano X, Francois TP, Viaud JY, Bukowski JG, Bourgeonneau MC, Cottron D, et al. Aspiration pneumonitis prophylaxis in obstetric anaesthesia: comparison of effervescent cimetidine‐sodium citrate mixture and sodium citrate. British Journal of Anaesthesia 1990;64:503‐6. - PubMed
Orr 1993 {published data only}
    1. Orr DA, Bill KM, Gillon KRW, Wilson CM, Fogarty DJ, Moore J. Effects of omeprazole, with and without metoclopramide, in elective obstetric anaesthesia. Anaesthesia 1993;48:114‐9. - PubMed
Osman 1995 {published data only}
    1. Osman H. Ranitidine versus cimetidine prior to emergency obstetric anesthesia. Middle East Journal of Anesthesiology 1995;13(2):205‐11. - PubMed
Ostheimer 1982 {published data only}
    1. Ostheimer GW, Morrison JA, Lavoie C, Sepkoski C, Hoffman J, Datta S. The effect of cimetidine on the mother, newborn and neonatal neurobehavior. Anesthesiology 1982;57:A405.
Ozkan 2000 {published data only}
    1. Ozkan T, Senturk M, Yavru A, Celebi S, Pembeci K. Does preoperative fluid fasting have a benefit on aspiration prophylaxis in obstetric anaesthesia [Obstetrik anestezide preoperatif oral sivi alimi aspirasyon pnomonisi profilaksisine katki saglar mi?]. Turk Anesteziyoloji Ve Reanimasyon 2000;28:425‐9.
Pickering 1980 {published data only}
    1. Pickering BG, Palahniuk RJ, Cumming M. Cimetidine premedication in elective caesarean section. Canadian Anaesthetists Society Journal 1980;27:33‐5. - PubMed
Rocke 1994 {published data only}
    1. Rocke DA, Rout CC, Gouws E. Intravenous administration of the proton pump inhibitor omeprazole reduces the risk of acid aspiration at emergency cesarean section. Anesthesia & Analgesia 1994;78:1093‐8. - PubMed
Roper 1981 {published data only}
    1. Roper RE, Salem MG. Effects of glycopyrrolate and atropine combined with antacid on gastric acidity. British Journal of Anaesthesia 1981;53:1277‐80. - PubMed
Rout 1993 {published data only}
    1. Rout CC, Rocke DA, Gouws E. Intravenous ranitidine reduces the risk of acid aspiration of gastric contents at emergency cesarean section. Anesthesia & Analgesia 1993;76:156‐61. - PubMed
Stuart 1996 {published data only}
    1. Gin T, Stuart JC, Kan AF, Rowbottom SJ, Yau G. IV ranitidine or omeprazole for emergency caesarean section. Anaesthesia and Intensive Care 1994;22:483.
    1. Stuart JC, Kan AF, Rowbottom SJ, Yau G, Gin T. Acid aspiration prophylaxis for emergency caesarean section. Anaesthesia 1996;51(5):415‐21. - PubMed
Tripathi 1995 {published data only}
    1. Tripathi A, Somwanshi M, Singh B, Bajaj P. A comparison of intravenous ranitidine and omeprazole on gastric volume and ph in women undergoing emergency caesarean section. Canadian Journal of Anaesthesia 1995;42(9):797‐800. - PubMed
Tryba 1983 {published data only}
    1. Tryba M, Burkert W, Husch M, Zenz M. Effectiveness of cimetidine in the prevention of aspiration pneumonia in obstetrics [Wirksamkeit von Cimetidin zur Prophylaxe der Aspirationspneumonie in der Geburtshilfe]. Fortschritte der Medizin 1983;101:1757‐61. - PubMed
von Braun 1994 {published data only}
    1. Braun GG, Koppert W, Martus P, Schywalsky M, Schmitt H, Mogendorf F, et al. Drug induced prevention of the acid aspiration syndrome in non‐elective cesarean section. Anaesthesiologie und Reanimation 1994;19:37‐42. - PubMed
Wig 1987 {published data only}
    1. Wig J, Biswas GC, Malhotra SK, Gupta AN. Comparison of sodium citrate with magnesium trisilicate as pre‐anaesthetic antacid in emergency caesarean sections. Indian Journal of Medical Research 1987;85:306‐10. - PubMed
Yau 1992 {published data only}
    1. Yau G, Kan AF, Gin T, Oh TE. A comparison of omeprazole and ranitidine for prophylaxis against aspiration pneumonitis in emergency caesarean section. Anaesthesia 1992;47:101‐4. - PubMed
Zoroglu 1999 {published data only}
    1. Zoroglu F, Karamanlioglu B, Pamukcu Z. The value of nizatidine and famotidine in the prophylaxis of acid aspiration pneumonia in cesarean operation [Elektif sezaryen ameliyatlarinda nizatidin ve famotidinin asit aspirasyon pnomonisi profilaksisindeki degeri]. Turk Anesteziyoloji Ve Reanimasyon 2000;28(10):521‐6.
    1. Zoroglu F, Karamanlioglu B, Unal C, Pamukcu Z. The value of nizatidine and famotidine in prophylaxis of aspiration pneumonia in caesarean section. British Journal of Anaesthesia 1999;82 Suppl:159‐60.
Zue 1999 {published data only}
    1. Zue AS, Meye JF, Nguema PN, Nsafu DN, Milama EN. Effervescent ranitidine before urgent caesarean section: effect on gastric pH [Ranitidine effervescente avant cesarienne en urgence: effet sur le pH gastrique]. Cahiers d Anesthesiologie 1999;47:1‐3.

References to studies excluded from this review

Abboud 1984 {published data only}
    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
Abouleish 1999 {published data only}
    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
Ackerman 1987 {published data only}
    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 May 20‐23; Halifax, Nova Scotia, Canada. 1987:143.
Ackerman 1988 {published data only}
    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.
Ackerman 1989 {published data only}
    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.
Apiliogullari 2008 {published data only}
    1. Apiliogullari S, Gok F, Canpolat A, Soysal S, Toy H. Comparison of prophylactic dimenhydrinate and metoclopramide for prevention of nausea‐vomiting caused by intrathecal opioids in parturients undergoing caesarean delivery. Regional Anesthesia and Pain Medicine 2008;33(5 Suppl 1):131.
Atkinson 1980 {published data only}
    1. Atkinson RE, Thomas T, Nicholas ADG, Anderson I. An antacid comparison trial. Anaesthesia 1980;35:1126‐30.
Avramovic 1979 {published data only}
    1. Avramovic D, Sulovic V, Lazarevic B, Cvetkovic M, Milacic D. Prevention of postoperative abdominal discomfort and gastrointestinal distension after cesarean section by use of simeticon. Jugoslavenska Ginekologija I Opstetricija 1979;19(5‐6):307‐11. - PubMed
Ayorinde 2000 {published data only}
    1. Ayorinde B, Brown J, Buczkowski P, Shah J, Buggy DJ. Prevention of spinal anaesthesia‐induced hypotension during caesarean section: comparative sudy of pre‐emptive vasopressors. British Journal of Anaesthesia 2000;84(2):277P‐288P. - PubMed
Ayorinde 2001 {published data only}
    1. Ayorinde BT, Buczkowski P, Brown J, Shah J, Buggy DJ. Evaluation of pre‐emptive intramuscular phenylephrine and ephedrine for reduction of spinal anaesthesia‐induced hypotension during caesarean section. British Journal of Anaesthesia 2001;86(3):372‐6. - PubMed
Belzarena 1993 {published data only}
    1. Belzarena SD. Addition of epinephrine to a combination of bupivacaine and fentanyl in spinal anesthesia for cesarean section. Regional Anesthesia 1993;18(1 Suppl 1):15.
Birnbach 1993 {published data only}
    1. Birnbach DJ, Stein DJ, Saunders TA, Grunebaum A, Kitain EM. Prophylactic use of acupressure for the prevention of nausea and vomiting during spinal anesthesia for cesarean section. Anesthesiology 1993;79:A1020.
Biswas 2003 {published data only}
    1. Biswas BN, Rudra A, Das SK, Nath S, Biswas SC. A comparative study of glycopyrrolate, dexamethasone and metoclopramide in control of post‐operative nausea and vomiting after spinal anaesthesia for caesarean delivery. Indian Journal of Anaesthesia 2003;47(3):198‐200.
Biwas 2002 {published data only}
    1. Biwas SC, Biswas BN, Rudra A, Pan A. A comparative study of metoclopramide, glycopyrrolate and combination of metoclopramide and glycopyrrolate in control of intraoperative and postoperative nausea and vomiting after spinal anaethesia for caesarean section. Journal of Obstetrics and Gynecology of India 2002;52(3):73‐5.
Bonhomme 2002 {published data only}
    1. Bonhomme V, Brichant JF, Wuilmart M, Dewandre PY, Hans P. Droperidol reduces nausea after caesarean section but alters the neurological status of the breastfed infants [abstract]. Anesthesiology 2002;96:A1044.
Boone 2002 {published data only}
    1. Boone JB, Gao GG, Clark CP, Chaudhuri S, Chaudhuri K. Dolasetron for prevention of perioperative nausea and vomiting during cesarean section under regional anesthesia [abstract]. Anesthesiology 2002;96 Suppl:A1069.
Boschi 1984 {published data only}
    1. Boschi S, Di MMG, Pigna A, Rossi R. The effect of ranitidine on gastric ph and volume in patients undergoing cesarean section: Possible relationship to Mendelson's syndrome. Current Therapeutic Research, Clinical and Experimental 1984;35(4):654‐62.
Brock‐Utne 1989 {published data only}
    1. Brock‐Utne JG, Rout C, Moodley J, Mayat N. Influence of preoperative gastric aspiration on the volume and pH of gastric contents in obstetric patients undergoing caesarean section. British Journal of Anaesthesia 1989;62:397‐401. - PubMed
Brody 2008 {published data only}
    1. Brody R. Study of the effect of intramuscular ephedrine on the incidence of nausea and vomiting during elective cesarean section. ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 20 February 2008) 2008.
Caba 1997 {published data only}
    1. Caba F, Echevarria M, Bernal‐Davalos L, Pallares‐Gonzalez JA, Rodriguez‐Rodriguez R. Prophylaxis for intraoperative nausea and vomiting with nonhypnotic doses of propofol during intradural anesthesia for cesarean delivery [Profilaxis de las nauseas y los vomitos intraoperatorios con dosis subhipnoticas de propofol durante la anestesia intradural en cesareas]. Revista Espanola De Anestesiologia y Reanimacion 1997;44:262‐6. - PubMed
Chan 1992 {published data only}
    1. Chan YK. A comparison of sodium citrate and sodium citrate/ranitidine combination for acid aspiration prophylaxis. Medical Journal of Malaysia 1992;47(1):27‐30. - PubMed
Chan 1997 {published data only}
    1. Chan WS, Irwin MG, Tong WN, Lam YH. Prevention of hypotension during spinal anaesthesia for caesarean section: ephedrine infusion versus fluid preload. Anaesthesia 1997;52(9):908‐13. - PubMed
Charuluxananan 2003 {published data only}
    1. Charuluxananan S, Kyokong O, Somboonviboon W, Narasethakamol A, Promlok P. Nalbuphine versus ondansetron for prevention of intrathecal morphine‐induced pruritus after cesarean delivery. Anesthesia and Analgesia 2003;96(6):1789‐93. - PubMed
Chaudhuri 2004 {published data only}
    1. Chaudhuri K, Chaudhuri S, Lampe C, Rivera J, Solis‐Estrada J. Does addition of dolasetron to metoclopramide alter nausea and vomiting in cesarean section patients under regional anesthesia [abstract]. Anesthesiology 2004;101 Suppl:A1234.
Chen 2005 {published data only}
    1. Chen HM, Chang FY, Hsu CT. Effect of acupressure on nausea, vomiting, anxiety and pain among post‐cesarean section women in Taiwan. Kaohsiung Journal of Medical Sciences 2005;21(8):341‐50. - PMC - PubMed
Cherian 2001 {published data only}
    1. Cherian VT, Smith I. Prophylactic ondansetron does not improve patient satisfaction in women using pca after caesarean section. British Journal of Anaesthesia 2001;87(3):502‐4. - PubMed
Chestnut 1987 {published data only}
    1. Chestnut DH, Bates JN, Choi WW, Vandewalker GE. Administration of metoclopramide for prevention of nausea and vomiting during regional anesthesia for cesarean section: a randomized, double blind, placebo controlled study. Anesthesiology 1986;65:390. - PubMed
    1. Chestnut DH, Vandewalker GE, Owen CL, Bates JN, Choi WW. Administration of metoclopramide for prevention of nausea and vomiting during epidural anesthesia for elective cesarean section. Anesthesiology 1987;66:563‐6. - PubMed
Chestnut 1989 {published data only}
    1. Chestnut DH, Owen CL, Geiger M, Bates JN, Choi WW, Ostman PL. Metoclopramide versus droperidol for prevention of nausea and vomiting during epidural anesthesia for cesarean section. Southern Medical Journal 1989;82(10):1224‐7. - PubMed
    1. Chestnut DH, Owen CL, Ostman LG, Bates JN, Choi WW. A comparison of metoclopramide and droperidol for prevention of nausea and vomiting during and after elective cesarean section with epidural anesthesia. Proceedings of 19th Annual Meeting of Society for Obstetric Anesthesia and Perinatology; 1987 May 20‐23; Halifax, Nova Scotia, Canada. 1987:118.
Chung 1998 {published data only}
    1. Chung CJ, Kim JS, Park HS, Chin YJ. The efficacy of intrathecal neostigmine, intrathecal morphine, and their combination for post‐cesarean section analgesia. Anesthesia and Analgesia 1998;87(2):341‐6. - PubMed
Cohen 1983 {published data only}
    1. Cohen SE, Barrier G. Does metoclopramide decrease gastric volume in cesarean section patients?. Anesthesiology 1983;59:A403. - PubMed
    1. Cohen SE, Jasson J, Talafre ML, Chauvelot‐Moachon L, Barrier G. Does metoclopramide decrease the volume of gastric contents in patients undergoing cesarean section?. Anesthesiology 1984;61:604‐7. - PubMed
Colman 1988 {published data only}
    1. Colman RD, Frank M, Loughnan BA, Cohen DG, Cattermole R. Use of i.m. ranitidine for the prophylaxis of aspiration pneumonitis in obstetrics. British Journal of Anaesthesia 1988;61:720‐9. - PubMed
Connelly 1997 {published data only}
    1. Connelly NR, Rahimi A, Parker RK. Nalmefene or naloxone for preventing intrathecal opioid mediated side effects in cesarean delivery patients. International Journal of Obstetric Anesthesia 1997;6:231‐4. - PubMed
Cooper 2002 {published data only}
    1. Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean section. Anesthesiology 2002;97:1582‐90. - PubMed
Cowan 2002 {published data only}
    1. Cowan CM, Kendall JB, Barclay PM, Wilkes RG. Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia. British Journal of Anaesthesia 2002;89(3):452‐8. - PubMed
Dahlgren 1997 {published data only}
    1. Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesthesia & Analgesia 1997;85(6):1288‐93. - PubMed
Dailey 1985 {published data only}
    1. Dailey PA, Hughes SC, Rosen MA, Healy K, Cheek DBC, Pytka S, et al. Lidocaine levels during cesarean section after pretreatment with ranitidine or cimetidine. Anesthesiology 1985;63:444.
Dailey 1988 {published data only}
    1. Dailey PA, Hughes SC, Rosen MA, Healy K, Cheek DBC, Shnider SM. Effect of cimetidine and ranitidine on lidocaine concentrations during epidural anesthesia for cesarean section. Anesthesiology 1988;69:1013‐7. - PubMed
Datta 1982 {published data only}
    1. Datta S, Alper MH, Ostheimer GW, Weiss JB. Method of ephedrine administration and nausea and hypotension during spinal anesthesia for cesarean section. Anesthesiology 1982;56:68‐70. - PubMed
Dewan 1982 {published data only}
    1. Dewan DM, Wheeler AS, James FM III, Floyd HM, Rhyne L. Antacid anticholinergic regimens in patients undergoing elective caesarean section. Canadian Anaesthetists Society Journal 1982;29:27‐30. - PubMed
Duggal 1998 {published data only}
    1. Duggal KN, Douglas MJ, Peter EA, Merrick PM. Acupressure for intrathecal narcotic‐induced nausea and vomiting after caesarean section. International Journal of Obstetric Anesthesia 1998;7(4):231‐6. - PubMed
Dundee 1979 {published data only}
    1. Dundee JW, Howe JP, Moore J, McCaughey W. Effect of cimetidine on gastric pH in women undergoing elective caesarean section [proceedings]. British Journal of Clinical Pharmacology 1979;8:391P‐392P. - PubMed
Fan 1994 {published data only}
    1. Fan SZ, Susetio L, Wang YP, Cheng YJ, Liu CC. Low dose of intrathecal hyperbaric bupivacaine combined with epidural lidocaine for cesarean section ‐ a balance block technique. Anesthesia and Analgesia 1994;78:474‐7. - PubMed
Flynn 1989a {published data only}
    1. Flynn RJ, Moore J, Collier PS, McClean E. Does pretreatment with cimetidine and ranitidine affect the disposition of bupivacaine?. British Journal of Anaesthesia 1989;62:87‐91. - PubMed
Flynn 1989b {published data only}
    1. Flynn RJ, Moore J. Does cimetidine effect plasma lidocaine levels in the parturient?. Anesthesia & Analgesia 1989;68:S87. - PubMed
    1. Flynn RJ, Moore J, Collier PS, Howard PJ. Effect of intravenous cimetidine on lignocaine disposition during extradural caesarean section. Anaesthesia 1989;44:739‐41. - PubMed
Flynn 1989c {published data only}
    1. Flynn RJ, Moore J. Effect of H2‐receptor antagonists on plasma lignocaine concentrations in the obstetric patient. British Journal of Anaesthesia 1988;61:512P.
    1. Flynn RJ, Moore J. Lack of effect of cimetidine and ranitidine on lidocaine disposition in the parturient. Anesthesiology 1988;69:A656.
    1. Flynn RJ, Moore J, Collier PS, Howard PJ. Single dose oral H2‐antagonists do not affect plasma lidocaine levels in the parturient. Acta Anaesthesiologica Scandinavica 1989;33:593‐6. - PubMed
Freeman 1999 {published data only}
    1. Freeman J, Lafreniere L, Watkins E, Dresner M. Does sodium citrate increase sickness associated with spinal anaesthesia for caesarean section?. British Journal of Anaesthesia 1999;82 Suppl:160.
Fujii 1998a {published data only}
    1. Fujii Y, Tanaka H, Toyooka H. Granisetron prevents nausea and vomiting during spinal anaesthesia for caesarean section. Acta Anaesthesiologica Scandinavica 1998;42(3):312‐5. - PubMed
Fujii 1998b {published data only}
    1. Fujii Y, Tanaka H, Toyooka H. Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for caesarean section: a randomized, double‐blind, placebo‐controlled trial. Acta Anaesthesiologica Scandinavica 1998;42(8):921‐5. - PubMed
Fujii 1999 {published data only}
    1. Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Granisetron/dexamethasone combination for reducing nausea and vomiting during and after spinal anesthesia for cesarean section. Anesthesia & Analgesia 1999;88(6):1346‐50. - PubMed
Fujii 2002 {published data only}
    1. Fujii Y, Numazaki M. Dose‐range effects of propofol for reducing emetic symptoms during cesarean delivery. Obstetrics & Gynecology 2002;99:75‐9. - PubMed
Fujii 2004 {published data only}
    1. Fujii Y, Numazaki M. Randomized, double‐blind comparison of subhypnotic‐dose propofol alone and combined with dexamethasone for emesis in parturients undergoing cesarean delivery. Clinical Therapeutics 2004;26(8):1286‐91. - PubMed
Gaiser 2002 {published data only}
    1. Gaiser RR, Dong Y, Cheek TG, Gutsche BB. Does increased intravenous hydration decrease the incidence of nausea/vomiting following cesarean section? [abstract]. Anesthesiology 2002;96(Suppl 1):P83.
Ghods 2005 {published data only}
    1. Ghods AA, Soleimani M, Narimani M. Effect of postoperative supplemental oxygen on nausea and vomiting after cesarean birth. Journal of Perianesthesia Nursing 2005;20(3):200‐5. - PubMed
Gutsche 1976 {published data only}
    1. Gutsche BB. Prophylactic ephedrine preceding spinal analgesia for cesarean section. Anesthesiology 1976;45:462‐5. - PubMed
Habib 2006 {published data only}
    1. Habib AS, Itchon‐Ramos N, Phillips‐Bute BG, Gan TJ, the Duke Women's Anesthesia (DWA) Research Group. Transcutaneous acupoint electrical stimulation with the ReliefBand for the prevention of nausea and vomiting during and after cesarean delivery under spinal anesthesia. Anesthesia & Analgesia 2006;102(2):581‐4. - PubMed
Harmon 2000 {published data only}
    1. Harmon D, Ryan M, Kelly A, Bowen M. Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. British Journal of Anaesthesia 2000;84(4):463‐7. - PubMed
    1. Harmon D, Ryan M, Kelly A, Bowen M. Acupressure and the prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. British Journal of Anaesthesia 1999;82 Suppl:161. - PubMed
Hildyard 2000 {published data only}
    1. Hildyard C, Freeman J, Dresner M. Reducing the incidence of postoperative nausea and vomiting following elective caesarean section under spinal anaesthesia [abstract]. International Journal of Obstetric Anesthesia 2000;9:199.
    1. Hildyard CL, Quinn A, Dresner M, Freeman J. Cyclizine reduces the incidence of nausea and vomiting after elective caesarean section with intrathecal diamorphine [abstract]. British Journal of Anaesthesia 2001;87(4):672P.
Ho 1996 {published data only}
    1. Ho CM, Hseu SS, Tsai SK, Lee TY. Effect of P‐6 acupressure on prevention of nausea and vomiting after epidural morphine for post‐Cesarean section pain relief. Acta Anaesthesiologica Scandinavica 1996;40:372‐5. - PubMed
Ho 2006 {published data only}
    1. Ho CM, Tsai HJ, Chan KH, Tsai SK. P6 acupressure does not prevent emesis during spinal anesthesia for cesarean delivery. Anesthesia & Analgesia 2006;102(3):900‐3. - PubMed
    1. Ho CM, Tsai SK. P‐6 acupressure do not prevent emesis during cesarean section [abstract]. Canadian Journal of Anesthesia 2002;49(6 Suppl):A51.
Holdsworth 1974 {published data only}
    1. Holdsworth JD, Furness RMB, Roulston RG. A comparison of apomorphine and stomach tubes for emptying the stomach before general anaesthesia in obstetrics. British Journal of Anaesthesia 1974;46:526‐9. - PubMed
Holdsworth 1978 {published data only}
    1. Holdsworth JD. The place of apomorphine prior to obstetric analgesia. Journal of International Medical Research 1978;6:26‐32. - PubMed
Holdsworth 1980 {published data only}
    1. Holdsworth JD, Johnson K, Mascall G, Gwynne Roulston R, Tomlinson PA. Mixing of antacids with stomach contents. Anaesthesia 1980;35:641‐50. - PubMed
Huang 1992 {published data only}
    1. Huang WP. Clinical observation of reliefing traction responses during cesarean section. Chinese Journal of Anesthesiology 1992;12(1):33.
Hunt 1989 {published data only}
    1. Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S, et al. Perioperative analgesia with subarachnoid fentanyl‐bupivacaine for cesarean delivery. Anesthesiology 1989;71:535‐40. - PubMed
Hussain 2011 {published data only}
    1. Hussain S, Khan RA, Iqbal M, Shafiq M, Khan FA. A comparison of the effects of erythromycin and metoclopramide on gastric fluid volume and pH in patients undergoing elective caesarean section. Anaesthesia, Pain and Intensive Care 2011;15(3):148‐52.
Imbeloni 1986 {published data only}
    1. Imbeloni LE, Santos JMM, Santos MM. Prophylactic use of metoclopramide for control of nausea and vomiting during epidural anesthesia for cesarean section [Uso profilatico da metoclopramida no controle de nauseas e vomitos durante anestesia peridural para cesariana]. Revista Brasileira de Anestesiologia 1986;36(4):295‐8.
Ishiyama 2001 {published data only}
    1. Ishiyama T, Yamaguchi T, Kashimoto S, Kumazawa T. Effects of epidural fentanyl and intravenous flurbiprofen for visceral pain during cesarean section under spinal anesthesia. Journal of Anesthesia 2001;15:69‐73. - PubMed
Jabalameli 2011 {published data only}
    1. Jabalameli M, Rouholamin S, Gourtanian F. A comparison of the effects of fentanyl and remifentanil on nausea, vomiting, and pain after cesarean section. Iranian Journal of Medical Sciences 2011;36(3):183‐7. - PMC - PubMed
Kang 1982 {published data only}
    1. Kang YG, Abouleish E, Caritis S. Prophylactic intravenous ephedrine infusion during spinal anesthesia for cesarean section. Anesthesia & Analgesia 1982;61:839‐42. - PubMed
Kangas‐Saarela 1990 {published data only}
    1. Kangas‐Saarela T, Hollmen AI, Tolonen U, Eskelinen P, Alahuhta S, Jouppila R, et al. Does ephedrine influence newborn neurobehavioural responses and spectral EEG when used to prevent maternal hypotension during caesarean section?. Acta Anaesthesiologica Scandinavica 1990;34:8‐16. - PubMed
Kasodekar 2006 {published data only}
    1. Kasodekar S, Dhumne S, Balki M, Carvalho J. Prophylactic granisetron does not prevent nausea and vomiting during elective cesarean section under spinal anesthesia [abstract]. Anesthesiology 2006;104(Suppl 1):9. - PubMed
Khalayleh 2005 {published data only}
    1. Khalayleh K, Omar AA. Comparitive antiemetic efficacy of intrathecal fentanyl and intravenous metoclopromide, during Caesarean Section under spinal anaesthesia. Journal of the Bahrain Medical Society 2005;17(4):243‐7.
King 1998 {published data only}
    1. King SW, Rosen MA. Prophylactic ephedrine and hypotension associated with spinal anesthesia for cesarean delivery. International Journal of Obstetric Anesthesia 1998;7:18‐22. - PubMed
Kjaer 2006 {published data only}
    1. Kjaer K, Comerford M, Kondilis L, DiMaria L, Abramovitz S, Kiselev M, et al. Oral sodium citrate increases nausea amongst elective cesarean delivery patients. Canadian Journal of Anaesthesia 2006;53(8):776‐80. - PubMed
Kocamanoglu 2005 {published data only}
    1. Kocamanoglu IS, Baris S, Karakaya D, Sener B, Tur A, Cetinkaya M. Effects of granisetron with droperidol or dexamethasone on prevention of postoperative nausea and vomiting after general anesthesia for cesarean section. Methods and Findings in Experimental and Clinical Pharmacology 2005;27(7):489‐93. - PubMed
Kotelko 1989 {published data only}
    1. Kotelko DM, Rottman RL, Wright WC, Stone JJ, Yamashiro AY, Rosenblatt RM. Transderm SCOP decreases post‐cesarean nausea and vomiting in patients receiving epidural morphine. Anesthesiology 1988;69:A666. - PubMed
    1. Kotelko DM, Rottman RL, Wright WC, Stone JJ, Yamashiro AY, Rosenblatt RM. Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine. Anesthesiology 1989;71:675‐8. - PubMed
Lim 1991 {published data only}
    1. Lim SK, Elegbe EO. The use of single dose of sodium citrate as a prophylaxis against acid aspiration syndrome in obstetric patients undergoing caesarean section. Medical Journal of Malaysia 1991;46(4):349‐55. - PubMed
Lim 2001a {published data only}
    1. Lim TJ, Chiu JW, Tan HM. Transcutaneous acupoint electrical stimulation for prevention of perioperative nausea and vomiting during cesarean section with spinal anesthesia [abstract]. Anesthesiology 2001;95 Suppl:A1078.
Lim 2001b {published data only}
    1. Lim TJ, Lim E, Chiu JW, Tan HM. Perioperative antiemetic efficacy of dexamethasone 4mg in cesarean section under spinal anaesthesia [abstract]. Anesthesiology 2001;95 Suppl:A466.
Loughrey 2002 {published data only}
    1. Loughrey JP, Walsh F, Gardiner J. Prophylactic intravenous bolus ephedrine for elective caesarean section under spinal anaesthesia. European Journal of Anaesthesiology 2002;19(1):63‐8. - PubMed
Lussos 1992 {published data only}
    1. Lussos S, Bader A, Thornhill M, Datta S. The antiemetic efficacy of prophylactic metoclopramide for cesarean delivery. Anesthesiology 1991;75:A1081. - PubMed
    1. Lussos SA, Bader AM, Thornhill ML, Datta S. The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia. Regional Anesthesia 1992;17:126‐30. - PubMed
Mandell 1986 {published data only}
    1. Mandell G, Dewan DM, Howard G, Floyd HM. The effectiveness of low dose droperidol in controlling nausea and vomiting during epidural anesthesia for cesarean section. Anesthesiology 1986;65:391. - PubMed
Mandell 1992 {published data only}
    1. Mandell GL, Dewan DM, Howard G, Floyd HM. The effectiveness of low dose droperidol in controlling nausea and vomiting during epidural anesthesia for cesarean section. International Journal of Obstetric Anesthesia 1992;1:65‐8. - PubMed
Manullang 2000 {published data only}
    1. Manullang TR, Viscomi CM, Pace NL. Intrathecal fentanyl is superior to intravenous ondansetron for the prevention of perioperative nausea during cesarean delivery with spinal anesthesia. Anesthesia and Analgesia 2000;90:1162‐6. - PubMed
Maranhao 1988 {published data only}
    1. Maranhao MVM, Coelho VV, Ivo CMA, Maranhao MHC, Amaral EB. A comparative study between metoclopramide and droperidol in the control of nausea and vomit in patients subjected to spinal blockade during cesarean section [Estudo comparativo entre a metoclopramida e o droperidol no controle de nauseas e vomitos na operacao cesariana em gestantes submetidas a bloqueio subaracnoideo]. Revista Brasileira de Anestesiologia 1988;38(4):245‐9.
McCaughey 1981 {published data only}
    1. McCaughey W, Howe JP, Moore J, Dundee JW. Cimetidine in elective caesarean section. Effect on gastric acidity. Anaesthesia 1981;36:167‐72. - PubMed
Mebazaa 2003 {published data only}
    1. Mebazaa MS, Meftah RB, Abassi M, Miraoui W, Bessa Z, Ammar MSB. Post‐operative nausea and vomiting after spinal anesthesia for cesarean section [abstract]. Anesthesiology 2003;99:A1201.
Mukherjee 2006 {published data only}
    1. Mukherjee S, Rudra A, Mandal M, Kumar P. Optimum dose of propofol for prevention of emetic episodes during caesarean delivery: an evaluation. Journal of Anaesthesiology Clinical Pharmacology 2006;22(2):139‐43.
Murphy 1984 {published data only}
    1. Murphy DF, Nally B, Gardiner J, Unwin A. Effect of metoclopramide on gastric emptying before elective and emergency caesarean section. British Journal of Anaesthesia 1984;56:1113‐6. - PubMed
Ngan 2000 {published data only}
    1. Ngan Kee WD, Khaw KS, Lee BB, Lau TK, Gin T. A dose‐response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesthesia and Analgesia 2000;90:1390‐5. - PubMed
Ngan 2001 {published data only}
    1. Ngan Kee WD, Lau TK, Khaw KS, Lee BB. Comparison of metaraminol and ephedrine infusions for maintaining arterial pressure during spinal anesthesia for elective cesarean section. Anesthesiology 2001;95:307‐13. - PubMed
Ngan 2004a {published data only}
    1. Ngan Kee WD, Khaw KS, Ng FF. Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for caesarean section. British Journal of Anaesthesia 2004;92(4):469‐74. - PubMed
Ngan 2004b {published data only}
    1. Ngan Kee WD, Khaw KS, Ng FF, Lee BB. Prophylactic phenylephedrine infusion for preventing hypotension during spinal anesthesia for cesarean delivery. Anesthesia and Analgesia 2004;98:815‐21. - PubMed
Nortcliffe 2003 {published data only}
    1. Nortcliffe SA, Buggy DJ. Prophylaxis of nausea and vomiting after spinal morphine analgesia for caesarean section: comparison between cyclizine, dexamethasone, and placebo [abstract]. British Journal of Anaesthesia 2001;87(4):657P. - PubMed
    1. Nortcliffe SA, Shah J, Buggy DJ. Prevention of postoperative nausea and vomiting after spinal morphine for caesarean section: comparison of cyclizine, dexamethasone and placebo. British Journal of Anaesthesia 2003;90(5):665‐70. - PubMed
Numazaki 2000 {published data only}
    1. Numazaki M, Fujii Y. Subhypnotic dose of propofol for the prevention of nausea and vomiting during spinal anaesthesia for caesarean section. Anaesthesia and Intensive Care 2000;28(3):262‐5. - PubMed
Numazaki 2003 {published data only}
    1. Numazaki M, Fujii Y. Reduction of emetic symptoms during cesarean delivery with antiemetics: propofol at subhypnotic dose versus traditional antiemetics. Journal of Clinical Anesthesia 2003;15:423‐7. - PubMed
O'Sullivan 1988 {published data only}
    1. O'Sullivan GM, Smith M, Morgan B, Brighouse D, Reynolds F. H2 antagonists and bupivacaine clearance. Anaesthesia 1988;43:93‐5. - PubMed
Olsen 1994 {published data only}
    1. Olsen KS, Feilberg VL, Hansen CL, Rudkjobing O, Pedersen T, Kyst A. Prevention of hypotension during spinal anaesthesia for caesarean section. International Journal of Obstetric Anesthesia 1994;3:20‐4. - PubMed
Ouyang 2002 {published data only}
    1. Ouyang MW, Gu MN, Lin CS. Inhibiting effect of intrathecal fentanyl on intraoperative vomiting during cesarean delivery under epidural anesthesia. Journal of the First Military Medical University (Di Yi Junyi Daxue Xuebao) 2002;22(11):1037‐8. - PubMed
Owczarzak 1997 {published data only}
    1. Owczarzak D, Ghellar MR, Oliveira GR, Semeghini MM. Ondansetron and epidural morphine‐induced pruritus and emesis after caesarean section: comparison with metoclopramide [abstract]. British Journal of Anaesthesia 1997;78 Suppl 1:110.
Palmer 1991 {published data only}
    1. Palmer AW, Waugaman WR, Conklin KA, Kotelko DM. Does the administration of oral bicitra before elective cesarean section affect the incidence of nausea and vomiting in the parturient?. Nurse Anesthesia 1991;2(3):126‐33. - PubMed
Palmer 1995 {published data only}
    1. Palmer CM, Voulgaropoulos D, Alves D. Subarachnoid fentanyl augments lidocaine spinal anesthesia for cesarean delivery. Regional Anesthesia 1995;20(5):389‐94. - PubMed
Pan 1996 {published data only}
    1. Pan PH, Moore CH. Intraoperative antiemetic efficacy of prophylactic ondansetron versus droperidol for cesarean section patients under epidural anesthesia. Anesthesia & Analgesia 1996;83(5):982‐6. - PubMed
Pan 2001 {published data only}
    1. Pan P, Moore C, Fragneto R, Ross V, Justis G. Is antiemetic prophylaxis cost‐effective for cesarean section patients [abstract]. Anesthesiology 2000;93(3A):A1092.
    1. Pan PH, Moore C, Fragneto R, Ross V, Justis G. Efficacy and cost‐effectiveness of prophylactic ondansetron versus metoclopramide for cesarean section patients under epidural anesthesia [abstract]. Anesthesiology 2000;92 Suppl:A40.
    1. Pan PH, Moore CH. Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia. Journal of Clinical Anesthesia 2001;13(6):430‐5. - PubMed
    1. Pan PH, Moore CM. Efficacy and cost‐effectiveness of prophylactic ondansetron versus metoclopramide for cesarean section patients under epidural anesthesia [abstract]. Anesthesia and Analgesia 2000;90 Suppl:S295. - PubMed
Pan 2003 {published data only}
    1. Pan AK, Rudra A. Prophylactic single dose intravenous administration of ondansetron in the prevention of postoperative emetic symptoms during spinal anaesthesia for caesarean delivery. Indian Journal of Anaesthesia 2003;47(3):178‐80.
Peixoto 2006 {published data only}
    1. Peixoto AJ, Celich MF, Zardo L, Peixoto Filho AJ. Ondansetron or droperidol for prophylaxis of nausea and vomiting after intrathecal morphine. European Journal of Anaesthesiology 2006;23(8):670‐5. - PubMed
Pellegrini 2001 {published data only}
    1. Pellegrini JE, Bailey SL, Graves J, Paice JA, Shott S, Faut‐Callahan M. The impact of nalmefene on side effects due to intrathecal morphine at cesarean section. AANA Journal 2001;69(3):199‐205. - PubMed
Phillips 2007 {published data only}
    1. Phillips TW Jr, Broussard DM, Sumrall WD 3rd, Hart SR. Intraoperative oxygen administration does not reduce the incidence or severity of nausea or vomiting associated with neuraxial anesthesia for cesarean delivery. Anesthesia and Analgesia 2007;105(4):1113‐7. - PubMed
    1. Phillips TW, Hart SR, Broussard D, Sumrall WD. Effects of supplemental oxygen administration on the incidence of nausea/vomiting during regional anesthesia for cesarean section [abstract]. Anesthesiology 2005;102(Suppl 1):28.
Prakash 2006 {published data only}
    1. Prakash S, Joshi N, Gogia AR, Prakash S, Singh R. Analgesic efficacy of two doses of intrathecal midazolam with bupivacaine in patients undergoing cesarean delivery. Regional Anesthesia and Pain Medicine 2006;31(3):221‐6. - PubMed
Quiney 1995 {published data only}
    1. Quiney NF, Murphy PG. The effect of pretreatment with glycopyrrolate on emetic and hypotensive problems during caesarean section conducted under spinal anaesthesia [abstract]. International Journal of Obstetric Anesthesia 1995;4:66‐7.
Qvist 1983 {published data only}
    1. Qvist N, Storm K. Cimethidine pre‐anesthetic ‐ a prophylactic method against Mendelson's syndrome in cesarean section. Acta Obstetricia et Gynecologica Scandinavica 1983;62:157‐9. - PubMed
Qvist 1985 {published data only}
    1. Qvist N, Storm K, Holmskov A. Cimetidine as pre‐anesthetic agent for cesarean section: perinatal effects on the infant, the placental transfer of cimetidine and its elimination in the infants. Journal of Perinatal Medicine 1985;13:179‐83. - PubMed
Ramanathan 1983 {published data only}
    1. Ramanathan S, Masih A, Rock I, Chalon J, Turndorf H. Maternal and fetal effects of prophylactic hydration with crystalloids or colloids before epidural anesthesia. Anesthesia and Analgesia 1983;62:673‐8. - PubMed
Ramin 1994 {published data only}
    1. Ramin SM, Ramin KD, Cox K, Magness RR, Shearer VE, Grant NF. Comparison of prophylactic angiotensin II versus ephedrine infusion for prevention of maternal hypotension during spinal anesthesia. American Journal of Obstetrics and Gynecology 1994;171:734‐9. - PubMed
Rout 1992 {published data only}
    1. Rout CC, Rocke DA, Brijball R, Koovarjee RV. Prophylactic intramuscular ephedrine prior to caesarean section. Anaesthesia and Intensive Care 1992;20:448‐52. - PubMed
Rudra 2004a {published data only}
    1. Rudra A, Halder R, Sen A, Kundu S. Efficacy of low dose propofol for control of emetic episodes during caesarean delivery with spinal anaesthesia. Indian Journal of Anaesthesia 2004;48(1):31‐4.
Rudra 2004b {published data only}
    1. Rudra P, Rudra A. Comparison of intrathecal fentanyl and midazolam for prevention of nausea‐vomiting during caesaraean delivery under spinal anaesthesia. Indian Journal of Anaesthesia 2004;48(6):461‐4.
Sanansilp 1998 {published data only}
    1. Sanansilp V, Areewatana S, Tonsukchai N. Droperidol and the side effects of epidural morphine after cesarean section. Anesthesia and Analgesia 1998;86(3):532‐7. - PubMed
Santos 1984 {published data only}
    1. Santos A, Datta S. Prophylactic use of droperidol for control of nausea and vomiting during spinal anesthesia for cesarean section. Anesthesia and Analgesia 1984;63:85‐7. - PubMed
Sen 2001 {published data only}
    1. Sen A, Rudra A, Sarkar SK, Biswas B. Intrathecal midazolam for postoperative pain relief in caesarean section delivery. Journal of the Indian Medical Association 2001;99(12):683‐4, 686. - PubMed
Seyedhejazi 2007 {published data only}
    1. Seyedhejazi M, Madarek E. The effect of small dose bupivacaine‐fentanyl in spinal anesthesia on hemodynamic nausea and vomiting in cesarean section. Pakistan Journal of Medical Sciences 2007;23(5):747‐50.
Shahriari 2009 {published data only}
    1. Shahriari A, Khooshideh M, Heidari MH. Prevention of nausea and vomiting in caesarean section under spinal anaesthesia with midazolam or metoclopramide?. JPMA ‐ Journal of the Pakistan Medical Association 2009;59(11):756‐9. - PubMed
Shende 1998 {published data only}
    1. Shende D, Cooper GM, Bowden MI. The influence of intrathecal fentanyl on the characteristics of subarachnoid block for caesarean section. Anaesthesia 1998;53:702‐10. - PubMed
Siddik‐Sayyid 2002 {published data only}
    1. Siddik‐Sayyid SM, Aouad MT, Jalbout MI, Zalaket MI, Berzina CE, Baraka AS. Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean section. Anesthesia and Analgesia 2002;95:209‐13. - PubMed
Stein 1997 {published data only}
    1. Stein DJ, Birnbach DJ, Danzer BI, Kuroda MM, Grunebaum A, Thys DM. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesthesia and Analgesia 1997;84(2):342‐5. - PubMed
Tarhan 2007 {published data only}
    1. Tarhan O, Canbay O, Celebi N, Uzun S, Sahin A, Coskun F, et al. Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anesthesia for cesarean section. Minerva Anestesiologica 2007;73(12):629‐33. - PubMed
Taylor 1966 {published data only}
    1. Taylor G, Pryse‐Davies J. The prophylactic use of antacids in the prevention of the acid‐pulmonary‐aspiration syndrome (Mendelson's syndrome). Lancet 1966;1:288‐91. - PubMed
Tettambel 1983 {published data only}
    1. Tettambel MA. Preoperative use of antacids to prevent Mendelson's syndrome in cesarean section: a pilot study. Journal of the American Osteopathic Association 1983;82:858‐60. - PubMed
Tzeng 2000 {published data only}
    1. Tzeng JI, Wang JJ, Ho ST, Tang CS, Liu YC, Lee SC. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post‐caesarean section analgesia: comparison of droperidol and saline. British Journal of Anaesthesia 2000;85:865‐8. - PubMed
Ure 1999 {published data only}
    1. Ure D, James KS, McNeill M, Booth JV. Glycopyrrolate reduces nausea during spinal anaesthesia for caesarean section without affecting neonatal outcome. British Journal of Anaesthesia 1999;82(2):277‐9. - PubMed
Vercauteren 2000 {published data only}
    1. Vercauteren MP, Coppejans HC, Hoffmann VH, Mertens E, Adriaensen HA. Prevention of hypotension by a single 5‐mg dose of ephedrine during small‐dose spinal anesthesia in prehydrated cesarean delivery patients. Anesthesia and Analgesia 2000;90:324‐7. - PubMed
Wang 2001 {published data only}
    1. Wang JJ, Ho ST, Wong CS, Tzeng JI, Liu HS, Ger LP. Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post‐cesarean analgesia. Canadian Journal of Anaesthesia 2001;48(2):185‐90. - PubMed
Weiss 1995 {published data only}
    1. Weiss MD, Diaz F, Zuberi F, Milman B, Pasricha S. Subhypnotic doses of propofol for prevention of postoperative pruritus and nausea in cesarean section patients given spinal opioids. Anesthesiology 1995;83(3A):A960.
Yazigi 2002 {published data only}
    1. Yazigi A, Chalhoub V, Madi‐Jebara S, Haddad F, Hayek G. Prophylactic ondansetron is effective in the treatment of nausea and vomiting but not on pruritis after cesarean delivery with intrathecal sufentanil‐morphine. Journal of Clinical Anesthesia 2002;14:183‐6. - PubMed

References to studies awaiting assessment

Karamanlioglu 1995 {published data only}
    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.
Sarat 2007 {published data only}
    1. Sarat Singh S, Upendra Singh K, Ratan Singh N, Rajkumar G, Maniram SK, Deban Singh L. Prevention of nausea and vomiting in caesarean delivery under spinal anaesthesia with glycopyrrolate, metoclopramide and ondansetron ‐ a comparative study. JMS ‐ Journal of Medical Society 2007;21(3):138‐42.

Additional references

Bond 1979
    1. Bond VK, Stoelting MD, Gupta CD. Pulmonary aspiration syndrome after inhalation of gastric fluid containing antacids. Anesthesiology 1979;51:452‐3. - PubMed
Browne 1993
    1. Browne D, Powell H. Update on some earlier controversies. In: Morgan B editor(s). Controversies in Obstetric Anaesthesia. Vol. 2, London: Edward Arnold, 1993.
CEMD 2001
    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. London: RCOG, 2001.
Cohen 1984
    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
Ewart 1990b
    1. 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
Gibbs 1979
    1. Gibbs CP, Schwartz DJ, Wynne JW, Hood CI, Kuck EJ. Antacid pulmonary aspiration in the dog. Anesthesiology 1979;51:380‐5. - PubMed
Gin 1990
    1. Gin T, Ewart MC, Yau G, Oh TE. Effect of oral omeprazole on intragastric pH and volume in women undergoing elective caesarean section. British Journal of Anaesthesia 1990;65:616‐9. - PubMed
Grieff 1994
    1. Grieff JMC, Tordoff SG, Griffiths R, May AE. Acid aspiration chemoprophylaxis in 202 obstetric anaesthetic units in the UK. International Journal of Obstetric Anesthesia 1994;3:137‐42. - PubMed
Griffiths 2012
    1. Griffiths JD, Gyte GML, Paranjothy S, Brown HC, Broughton HK, Thomas J. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Cochrane Database of Systematic Reviews 2012, Issue 9. [DOI: 10.1002/14651858.CD007579.pub2] - DOI - PMC - PubMed
Gyte 2006
    1. Gyte GML, Richens Y. Routine prophylactic drugs in normal labour for reducing gastric aspiration and its effects. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD005298.pub2] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Mendelson 1946
    1. Mendelson CL. Aspiration of stomach contents into the lungs during obstetric anesthesia. American Journal of Obstetrics and Gynecology 1946;52:191‐203. - PubMed
Moore 1989
    1. Moore J, Flynn RJ, Sampaio M, Wilson CM, Gillon KR. Effect of single‐dose omeprazole on intragastric acidity and volume during obstetric anaesthesia. Anaesthesia 1989;44(7):459‐62. - PubMed
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Roberts 1974
    1. Roberts RB, Shirley MA. Reducing the risk of acid aspiration during cesarean section. Anesthesia and Analgesia 1974;53:859‐68. - PubMed
Singata 2002
    1. Singata M, Tranmer JE. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD003930] - DOI - PMC - PubMed
Sweeney 1986
    1. Sweeney B, Wright I. The use of antacids as a prophylaxis against Mendelson's syndrome in the United Kingdom. A survey. Anaesthesia 1986;41:419‐22. - PubMed
Thomas 2001
    1. Thomas J, Paranjothy S, Royal College of Obstetricians and Gynaecologists: Clinical Effectiveness Support Unit. The national sentinel caesarean section audit report. London: RCOG Press, 2001.
Thwaites 1999
    1. Thwaites AJ, Riche CP, Smith I. Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation. Anaesthesia 1999;54:372‐92. - PubMed
Tordoff 1990
    1. Tordoff SG, Sweeney BP. Acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom. Anaesthesia 1990;45:776‐80. - PubMed

References to other published versions of this review

Paranjothy 2010
    1. Paranjothy S, Griffiths JD, Broughton HK, Gyte GML, Brown HC, Thomas J. Interventions at caesarean section for reducing the risk of aspiration pneumonitis. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD004943.pub3] - DOI - PMC - PubMed

Publication types

MeSH terms