GM, BULLINGHAM RE. Noninvasive assessment by radiotelemetry of antacid effect during labor. Anesth Analg 1985;64:95-100.A noninvasive radiotelemetry technique was used to study the antacid effect of 15 ml of 0.3 M sodium citrate in 26 women in established labor. The subjects swallowed a pH radio pill, whose signal was detected transabdominally by a radio receiver. The median and range of values for the time to return to the preantacid basal pH for all of the women in labor was 84.0 (1 1. 8-195.8) min. However, there was a significant difference ( P < 0.05) in the duration of action of sodium citrate between the women who had received no analgesia and those given intramuscular meperidine. The median and range of values for the time to return to the preantacid basal pH in patients who had received meperidine during iabor was 166.0 (147.7-195.8) min, whilst in those who had received no analgesia the values were 56.7 (1 1.8-143.0) min. There were no significant differences between patients given no analgesia and those given extradural analgesia. Pretreatment with intrauaginal prostaglandins (PGE,) did not influence antacid effect.Numerous preventative and prophylactic measures are practiced in an attempt to reduce the risk of acid pulmonary aspiration (Mendelson's syndrome) (1) during labor and delivery. These include prohibition of solid food during labor, preoperative emptying of the stomach, oral administration of antacids during labor with an additional bolus prior to surgery, and the use of cricoid pressure during the induction of general anesthesia. More recently, the use of H2 receptor antagonists during labor and before cesarean section (2,3) has been suggested.The severity of Mendelson's syndrome is a function of the pH and volume of the aspirated fluid (4,5). In the past, because antacids did not always appear to provide protection against the effect of aspiration (6,7), larger volumes and their more frequent administration during labor were advocated (8,9). The known pulmonary toxicity associated with the aspiration of antacids (lo), the severity of which appears to depend upon the volume aspirated (ll), and the failure to improve maternal mortality despite the use of repeated doses of antacids (12) cast doubt on the validity of administering antacids prophylactically throughout labor.A recent study (13) using a noninvasive radiotelemetry technique demonstrated a wide variation in the efficacy and duration of action of both particulate and nonparticulate antacids. Nor was any difference found in antacid effect between pregnant and nonpregnant women (14). In addition, doubling the volume of the nonparticulate antacid 0.3 M sodium citrate from 15 ml to 30 ml was not found to produce a significantly greater effect (15). These studies did, however, indicate that one of the main factors determining the duration of antacid action was the rate of gastric emptying. During labor, antacid efficacy might differ from that in nonlaboring pregnant women, because of the gastrointestinal effects of labor itself, the asso...