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Correspondence |
Seoul, South Korea
To the Editor:
Aspiration of gastric contents has long been the main cause of anesthetic related maternal mortality in obstetric units. Although physiologic changes in maternal gastric secretion and emptying have been well documented,1,2 no studies have been conducted to compare the preoperative stomach contents between patients presenting for elective and intrapartum Cesarean deliveries nor to evaluate the risk factors for acid aspiration syndrome.
After obtaining the approval of the Ethics Committee and informed consents from the patients, preoperative gastric pH and volume were measured by direct aspiration using a 14-F multiorifice nasogastric tube in patients undergoing elective Cesarean delivery (n = 47) and in parturients requiring intrapartum emergency Cesarean delivery (n = 52) who had been starved for at least six hours and had refused labour analgesia. Investigated factors included preoperative fasting time, anxiety (visual analogue scale), blood glucose level, and serum gastrin concentration measured by the double antibody gastrin method, which is suspected to alter the preoperative gastric residue.3,4 The values were considered to be statistically significant at P < 0.05.
Duration of labour in the emergency group was 2.8 ± 3.3 hr (mean ± standard deviation). In the intrapartum group, the preoperative fasting time was longer than that of the elective group (13.4 ± 2.7 vs 15.7 ± 6.2 hr), but the blood sugar level was higher than that of the elective group (88.8 ± 22.0 vs 106.9 ± 29.9 mg·dL–1, P < 0.05). Preoperative anxiety (0 = no anxiety to 10 = extremely anxious) of the emergency group was significantly higher than that of the elective group (3.9 ± 2.0 vs 4.9 ± 2.1, P < 0.05). Preoperative gastric pH and volume of the two groups were not statistically different (Figure
). The number of patients considered to be at risk: pH < 2.5 and volume > 25 mL in the two groups were similar (38.3% vs 38.5%). In the elective group, there were significant correlations between gastric pH and fasting time, and between gastric volume and serum gastrin and glucose concentration. In the intrapartum group, there was a weak correlation between gastric pH and volume and preoperative anxiety and glucose concentration.
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References
1 Macfie AG, Magides AD, Richmond MN, Reilly CS. Gastric emptying in pregnancy. Br J Anaesth 1991; 67: 54–7.
2 Attia RR, Ebeid AM, Fischer JE, Goudsouzian NG. Maternal fetal and placental gastrin concentrations. Anaesthesia 1982; 37: 18–21.[Medline]
3 Simpson KH, Stakes AF. Effect of anxiety on gastric emptying in preoperative patients. Br J Anaesth 1987; 59: 540–4.
4 Gultekin F, Gurbilek M, Vatansev H, Yasar S, Akoz M, Ozturk M. Effect of oral glucose loading on serum gastrin level in pregnant and non-pregnant women. Croat Med J 2001; 42: 151–5.[Medline]
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