Antacid anticholinergic regimens in patients undergoing elective caesarean section

Area of Science:

• Anesthesiology
• Pharmacology
• Gastroenterology

Background:

• Cesarean sections require careful anesthetic management to prevent aspiration.
• Antacids are commonly used to increase gastric pH, but their efficacy can vary.
• Preoperative medication timing impacts the effectiveness of gastric acid reduction strategies.

Purpose of the Study:

• To evaluate the effect of Gelusil alone versus Gelusil combined with atropine or glycopyrrolate on gastric fluid pH and volume.
• To assess the efficacy of these regimens in preventing aspiration risk during elective Cesarean sections.
• To determine the influence of the interval between premedication and anesthetic induction on gastric pH.

Main Methods:

• Sixty patients undergoing elective Cesarean section were divided into three groups.
• Group 1 received Gelusil 30 ml orally.
• Groups 2 and 3 received Gelusil plus either atropine or glycopyrrolate intramuscularly, respectively. Gastric fluid was sampled post-intubation.

Main Results:

• Combined use of Gelusil with atropine or glycopyrrolate significantly increased gastric fluid pH compared to Gelusil alone (P < 0.01).
• The addition of atropine or glycopyrrolate reduced the incidence of low gastric pH (<2.5) when the interval exceeded 75 minutes.
• Both atropine and glycopyrrolate significantly decreased the combined incidence of low gastric pH and high gastric volume compared to Gelusil alone (P < 0.05).

Conclusions:

• Adding atropine or glycopyrrolate to Gelusil premedication enhances gastric acid suppression.
• These combinations provide additional protection against aspiration, particularly with prolonged intervals before anesthesia.
• The findings support the use of combined antacid and anticholinergic premedication for improved patient safety in Cesarean sections.