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Is aspiration prophylaxis necessary before spinal anesthesia for Cesarean section. ?

Houston, Texas, Usa

To the Editor:

Failure of spinal anesthesia (SA) for Cesarean section (CS) necessitating general anesthesia (GA) and tracheal intubation is extremely low. However, aspiration prophylaxis (AP) is recommended because of the possibility of either failure or excessive spread of spinal block requiring GA. We have reviewed, retrospectively, the penoperative course of parturients undergoing CS under SA at our hospital from 1991 to 1993. When spinal block failure occurred, sodium bicarbonate po was administered prior to GA. Among the 743 cases that we reviewed, failure occurred in 15 cases (2%) because of inadequate analgesia (1.9%) or prolonged surgery for hysterectomy (0.1%). No case required intubation due to excessive block. No pulmonary aspiration was identified. In a survey of 165 academic departments in the USA and Canada, Greenhalgh¹ found that 94% of elective and 99% of emergency CS patients received aspiration prophylaxis. Plumer² found that 88% of the anesthesiologists attending a major obstetric anesthesia conference in the USA routinely gave prophylaxis before CS was performed under regional anesthesia. By contrast, "in a confidential postal questionnaire among 297 French anesthesiologists, Benhamou³ found that only 23% of the respondents used prophylaxis before obstetric anesthesia.

Our study demonstrates that, in our institution, the incidence of spinal failure or excessive block necessitating GA/intubation was extremely low. Therefore, routine prophylaxis may not be necessary prior to spinal anesthesia. However, these results should be confirmed by a prospective, controlled studies. An antacid should be administered whenever GA is required.

References

1 Greenhalgh CA. Obstetric anesthesia. In: Greenhalgh CA, McLean JL. A Survey of Acid Aspiration in Academic Departments of United States and Canada: S.O.A.P Abstract Book, 1993: 6.

2 Plumer MH, Rothman R. How anesthesiologists practice obstetric anesthesia: responses of practicing obstetric anesthesiologists at the 1993 meeting of the Society for Obstetric Anesthesia and Perinatology. Reg Anesth 1996; 21: 49–60.[Medline]

3 Benhamou D. French obstetric anesthesia and acid aspiration prophylaxis. Eur J Anaesth 1993; 10: 27–32.[Medline]

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