[Drug induced prevention of the acid aspiration syndrome in non-elective cesarean section]

Abstract

Pulmonary aspiration of gastric content with a subsequent aspiration syndrome is a major cause of maternal mortality. Since regurgitation in patients undergoing general anaesthesia cannot reliably be excluded, a prophylaxis with specific drugs is recommendable. In a prospective investigation on patients undergoing nonelective Caesarean section, the H2-receptor antagonist famotidine (fam), the antacid sodium citrate (cit) and the dopamine antagonist metoclopramide (met) were evaluated with respect to volume and acidity of gastric juice. When indicated, a group of 255 patients received 20 mg famotidine i.v., with a randomised subgroup of 126 of these patients also receiving 10 mg metoclopramide i.v. A second group of 171 patients received 20 ml 0.3 M sodium citrate p.o., with a randomised subgroup of 75 of these patients receiving 10 mg metoclopramide i.v. in addition. After induction of anaesthesia the gastric content was evacuated via a gastric tube. Mean volume and pH of the gastric juice as well as the percentage of patients at risk for the development of an aspiration syndrome (juice volume > 0.4 ml/kg and pH < 2.5) were determined. Already in the first hour after drug administration a lower percentage of patients at risk could be observed compared to data from patients without prophylaxis published in recent studies (fam 18.2%, fam + met 12.0%, cit 1.9%, cit + met 2.2%). Treatment with sodium citrate was most effective because of a rapid increase in pH (cit vs. fam: p < 0.05, cit vs. fam + met: p < 0.1, cit + met vs. fam: p < 0.05, cit + met vs. fam+met: p < 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)