Aspiration Pneumonia Clinical Trial
Official title:
Ultrasound Assessment of Metoclopramide Effect on Gastric Volume in Patients Undergoing Cesarean Section: A Randomized, Double-blind, Cross-sectional Study"
the risk of aspiration pneumonitis during cesarean sections has significantly decreased. Nevertheless, precaution against gastric aspiration is still vital in patients in whom regional anesthesia contraindicated or in whom general anesthesia has to be administered (for example; during emergency cesarean delivery). The administration of intravenous anesthetics reduces the level of consciousness of a patient that compromises the protective reflexes of the upper airways. Moreover, a high level of sedation also reduces the tone of the LES (lower oesophageal sphincter). Both these situations predispose the risk of aspiration pneumonia in patients awaiting surgical interventions in supine position under general anesthesia
Since regional anesthesia has largely replaced general anesthesia, the risk of aspiration
pneumonitis during cesarean sections has significantly decreased. Nevertheless, precaution
against gastric aspiration is still vital in patients in whom regional anesthesia
contraindicated or in whom general anesthesia has to be administered (for example; during
emergency cesarean delivery). The administration of intravenous anesthetics reduces the level
of consciousness of a patient that compromises the protective reflexes of the upper airways.
Moreover, a high level of sedation also reduces the tone of the LES (lower oesophageal
sphincter). Both these situations predispose the risk of aspiration pneumonia in patients
awaiting surgical interventions in supine position under general anesthesia .
The risk of aspiration increases in outpatients if the volume of the gastric contents
increases beyond 25 ml, and its pH falls below 2.5. However, the risk of aspiration
significantly decreases in "fasted" outpatients. Since most patients awaiting elective
surgery remains fasted, routine prophylaxis for preventing aspiration pneumonitis not
recommended anymore. Studies suggest that metoclopramide, in combination with H2-receptor
antagonists (such as cimetidine), significantly reduces the risk of postoperative emesis and
aspiration pneumonitis. However, the time available for administering oral prophylaxis with
such anti-emetic and anti-histaminic is too short for these medications to be effective
;
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