The Aspiration of Stomach Contents Into the Lungs During Obstetric Anesthesia

Mendelson, Curtis L.

doi:10.1097/00006254-194612000-00024

Cited by 740 publications

(137 citation statements)

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“…1 This maneuver was introduced in 1961 when there was great concern about the number of maternal deaths from anesthesia related aspiration. 7 The onus was upon the profession to do something about this problem and Sellick's approach seemed very reasonable Changes in glottic view with manipulation in comparison to control group. *P = 0.007; M = male; F = female; total number of patients = 40. and practical at the time.…”

Section: Discussionmentioning

confidence: 99%

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

Snider

Clarke

Finucane

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The purpose of this study was to determine if the application of a BURP maneuver to the cricoid cartilage would combine the benefits of both the BURP and the Sellick maneuvers, resulting in an improved glottic view and offer the potential of protection against passive gastric regurgitation.M Me et th ho od ds s: : This was a double-blind, prospective, randomized, crossover trial. Forty-three patients scheduled for elective surgery participated in this study. General anesthesia was induced using fentanyl, propofol and rocuronium. In a random sequence for each case and blinded to the laryngoscopist, one of three maneuvers was carried out. Direct vertical pressure, using 30 newtons, a BURP maneuver with cricoid pressure, or no pressure was applied to the cricoid and the laryngoscopic view was ascertained. A separate laryngoscopy was conducted for each maneuver and the views were graded as good (part of the glottis seen), poor (only the arytenoids were seen) or no view (only the epiglottis was seen). Endotracheal intubation was then performed in each case. R Re es su ul lt ts s: :The results showed that the combination of the BURP maneuver and cricoid pressure worsened the view obtained at laryngoscopy in 30% of cases (P = 0.007). Cricoid pressure alone worsened the view in 12.5% of cases (P = 0.279). No difference was seen in 65% of cases. All patients but one were intubated easily.C Co on nc cl lu us si io on n: : There is no benefit to routinely applying a modified "BURP" maneuver to the cricoid cartilage during rapid sequence induction of anesthesia.

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Section: Discussionmentioning

confidence: 99%

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

Snider

Clarke

Finucane

2005

Can J Anesth/J Can Anesth

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“…26 This finding has led to justifying the use of the PLMA and SLMA in the management of the difficult airway in obstetrics. 27 Despite the low incidence of aspiration (1:667), even in the high-risk population, 28 there is still a need for prospective studies powered adequately to validate the safety of supraglottic devices in protecting against aspiration during anesthesia. Han et al 29 found no cases of aspiration in 1,060 patients who underwent elective LSCS with a LMA Classic TM , and Halaseh et al 30 found no cases of aspiration in 3,000 patients who underwent elective LSCS with a PLMA.…”

Section: Slma and Risk Of Aspirationmentioning

confidence: 99%

The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study

Yao¹,

Li²,

Sng

et al. 2012

Can J Anesth/J Can Anesth

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Background The LMA Supreme TM (SLMA) is a singleuse supraglottic device that provides a good seal for positive pressure ventilation. It has a double aperture design that facilitates the introduction of an orogastric tube to aspirate gastric contents. This observational study evaluated the role of the SLMA in parturients undergoing Cesarean delivery under general anesthesia. Methods Non-obese parturients with at least four hours of fasting and antacid prophylaxis scheduled for uncomplicated Cesarean delivery were recruited from June 2009 through May 2010 at the Quanzhou Women's and Children's Hospital, China. We recorded the number of SLMA insertion attempts, the time to effective ventilation, the incidence of aspiration, and other anesthetic and obstetric outcomes. Postoperatively, we noted the presence of blood on the SLMA, postoperative sore throat, and patient satisfaction. Analysis included comparison of results between parturients having elective and urgent Cesarean delivery. Results We recruited 700 parturients (576 elective, 124 urgent). Mean (standard deviation) body mass index was 25.6 (2.5) kgÁm -2 . All SLMA insertions were successful, with 686 (98%) inserted on first attempt and a time to effective airway of 19.5 (3.9) sec. We maintained ventilation and oxygenation in all parturients with a good seal and there was no evidence of aspiration. Eighteen parturients (2.6%) had blood on the SLMA upon removal, 24 (3.4%) had sore throat, and patient satisfaction was 85 (7)%. These results were similar in elective and urgent cases. Conclusions In a carefully selected group of parturients, the SLMA is a useful alternative to tracheal intubation for Cesarean delivery, providing effective ventilation and a low incidence of side effects or complications.

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“…Bronchospasm is a characteristic feature in all patients. Chest X-ray film changes consisting of soft, irregular, mottled densities in the right lower lobe or both lower lobes, are associated with frothy nonpurulent sputum (Mendelson 1946). Hypoxia, together with normal to lowered PCO 2 , indicates ventilation-perfusion disturbances .…”

Section: Radiological Findings Of Gastric Aspirationmentioning

confidence: 99%

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

Virkkunen¹

2009

Acta Anaesthesiol Scand

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The Aspiration of Stomach Contents Into the Lungs During Obstetric Anesthesia

Cited by 740 publications

References 0 publications

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

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