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Interventions at caesarean section for reducing the risk of aspiration pneumonitis

Paranjothy, Shantini, Griffiths, J. D., Broughton, Hannah K., Gyte, G. M. L., Brown, H. C. and Thomas, J. 2011. Interventions at caesarean section for reducing the risk of aspiration pneumonitis. International Journal of Obstetric Anesthesia 20 (2) , pp. 142-148. 10.1016/j.ijoa.2010.12.006

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Abstract

Background Various interventions are used as prophylaxis for aspiration pneumonitis in obstetric anaesthesia. This review, based on a Cochrane systematic review currently being updated, examines whether interventions given before caesarean section reduce the risk of aspiration pneumonitis. Methods Twenty-two studies, involving 2658 women providing data in a usable format for meta-analysis were identified. Results Compared to no treatment or placebo, there was a significant reduction in the risk of intra-gastric pH <2.5 with antacids (risk ratio (RR) 0.17, 95% confidence interval (CI) 0.09–0.32), H2 antagonists (RR 0.09, 95% CI 0.05–0.18) and proton-pump antagonists (RR 0.26, 95% CI 0.14–0.46). H2 antagonists were associated with a reduced risk of intra-gastric pH <2.5 when compared with proton-pump antagonists (RR 0.39, 95% CI 0.16–0.97), but compared with antacids the findings were unclear. Combined use of antacids plus H2 antagonists was associated with a significant reduction in the risk of intra-gastric pH <2.5 when compared with placebo (RR 0.02, 95% CI 0.00–0.15) or compared with antacids alone (RR 0.12, 95% CI 0.02–0.92). Conclusion The quality of evidence was weak and may not reflect a reduction in the risk of aspiration pneumonitis since none of the studies assessed substantive clinical outcomes or potential adverse effects. Further work is required to validate the suitability of surrogate markers of pH and gastric volume for clinical outcomes in the context of aspiration pneumonitis.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > RG Gynecology and obstetrics
Uncontrolled Keywords: aspiration pneumonitis ; caesarean section ; antacids ; H2 antagonists ; proton-pump inhibitors
Publisher: Elsevier
ISSN: 0959-289X
Last Modified: 05 Jun 2017 03:07
URI: http://orca.cf.ac.uk/id/eprint/25475

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