Interventions at caesarean section for reducing the risk of aspiration pneumonitis

Paranjothy, Shantini; Griffiths, J. D.; Broughton, Hannah K.; Gyte, Gillian ML; Brown, H. C.; Thomas, Justin

doi:10.1016/j.ijoa.2010.12.006

Cited by 19 publications

(20 citation statements)

References 36 publications

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“…The commonest regimen for stomach preparation before elective caesarean section [38] is a combination of a H 2 -receptor antagonist the night before and two hours before anaesthesia, with or without a prokinetic drug. If general anaesthesia is being used, sodium citrate is also administered immediately before induction [38,39].…”

Section: Classification Of Evidencementioning

confidence: 99%

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Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

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SummaryThe Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably secondgeneration) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

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Section: Classification Of Evidencementioning

confidence: 99%

“…If anaesthesia is required for delivery, an H 2 -receptor antagonist should be given intravenously if not already administered, with the aim of reducing the risk of aspiration at extubation. Sodium citrate should be given as for elective cases [38,39].…”

Section: Classification Of Evidencementioning

confidence: 99%

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

View full text Add to dashboard Cite

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“…Tervezett és sürgős műtét esetén is ajánlott 30 ml Na-citricum itatása. Vizsgálatok kimutatták, hogy H2-blokkoló és antacidum együttes adásával csökkenthető leghatékonyabban a gyomortartalom nem kívánt vegyhatása [13].…”

Section: Az Anesztéziából Eredő Anyai Halálozásunclassified

Obstetrical aspects of perioperative medicine

Hupuczi

Gál

2014

Orvosi Hetilap

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Napjainkban a világon a leggyakrabban végzett sebészi beavatkozás a császármetszés. Alapvető feltétel, hogy a műté-tet szövődménymentesen lehessen végezni és a gyermekágyasok gyors posztoperatív felépülése biztosítható legyen, hiszen az anya-újszülött kapcsolatot már a műtét napján lehetővé kell tenni. A császármetszések mortalitása az elmúlt évtizedekben lényegesen csökkent, ez jelentős teammunka eredménye, valamint köszönhető a széles körben elterjedt gerincközeli érzéstelenítő eljárásoknak. A perinatológusteam tagja a szülészen és a neonatológuson kívül az aneszteziológus is, aki a páciens perioperatív ellátásáért felel. A szövődmények megelőzésének és korai eredményes kezelésé-nek a feltétele, hogy az aneszteziológus már a terhesség során ismerkedjék meg a várandós nő állapotával, hogy megtervezhesse a perioperatív ellátást. A szerzők ismertetik a nagy kockázatú szülőnők csoportjait, a leggyakoribb anyai halálokokat és a preventív, valamint terápiás lehetőségeket. Orv. Hetil., 2014, 155(29), 1147-1151.Kulcsszavak: epiduralis és spinalis anesztézia, anyai mortalitás, praeeclampsia/eclampsia, szülészeti vérzések, szülé-szeti szepszis, obesitas, perioperatív fájdalomcsillapítás Obstetrical aspects of perioperative medicineRecently the most frequently applied surgical procedure worldwide has been Cesarean section. It is essential to perform the operation without any complication. In addition, a fast postoperative recovery must be provided, because all mothers must have the chance for being together with their newborn infant even on the fi rst day. The maternal mortality rates of Cesarean section signifi cantly decreased in the last decades due to the planned team work as well as the widely applied regional (spinal and epidural) anesthetic procedures. Apart from the obstetrician and neonatologist the anesthesiologist is the member of the perinatal team, too, who is responsible for the patient's perioperative care. To prevent complications and have an early successful treatment the anesthesiologist should be informed by the pregnant woman' s health status in time in order to be able to plan the perioperative management. The high-risk groups of pregnant women, the most common causes of maternal death and possibilities of prevention and treatment are discussed.Keywords: epidural and spinal anesthesia, maternal mortality, preeclampsia/eclampsia, obstetric hemorrhages, obstetric sepsis, obesity, perioperative pain relief Az elmúlt két évtizedben a szülészeti gyakorlat alapvető változásainak lehetünk tanúi és részesei. Évek óta tapasztalható a gyermekvállalási kedv csökkenése, az első gyermek vállalása egyre idősebb anyai életkorban történik. A várandósgondozás fejlődésével ma már súlyosabb anyai betegségek sem képezik terhesség kiviselésének el-

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“…Combined with a decreased lower esophageal sphincter tone and increased gastric acid secretion, the chance of gastric regurgitation is increased. Acid aspiration prophylaxis (in our institution a combination of an H 2 receptor antagonist, sodium citrate orally 30 ml 0.3 M and metoclopramide) is therefore recommended to reduce gastric secretion and increase gastric pH [22]. …”

Section: Maternal Anesthetic Aspects Of Fetal Surgerymentioning

confidence: 99%

Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures

Velde

Buck

2012

Fetal Diagn Ther

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For many prenatally diagnosed conditions, treatment is possible before birth. These fetal procedures can range from minimal invasive punctions to full open fetal surgery. Providing anesthesia for these procedures is a challenge, where care has to be taken for both mother and fetus. There are specific physiologic changes that occur with pregnancy that have an impact on the anesthetic management of the mother. When providing maternal anesthesia, there is also an impact on the fetus, with concerns for potential negative side effects of the anesthetic regimen used. The question whether the fetus is capable of feeling pain is difficult to answer, but there are indications that nociceptive stimuli have a physiologic reaction. This nociceptive stimulation of the fetus also has the potential for longer-term effects, so there is a need for fetal analgesic treatment. The extent to which a fetus is influenced by the maternal anesthesia depends on the type of anesthesia, with different needs for extra fetal anesthesia or analgesia. When providing fetal anesthesia, the potential negative consequences have to be balanced against the intended benefits of blocking the physiologic fetal responses to nociceptive stimulation.

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Interventions at caesarean section for reducing the risk of aspiration pneumonitis

Cited by 19 publications

References 36 publications

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Obstetrical aspects of perioperative medicine

Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures

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