Acid aspiration prophylaxis for emergency Caesarean section

Over a 3.5 year period, 384 patients requiring emergency Caesarean section under general anaesthesia received at random one of six acid aspiration prophylaxis regimens as soon as the decision was made for surgery. In the first phase of the study, sodium citrate administered orally 0.3 M, 30 ml (group C, n = 120) was compared with metoclopramide 10 mg administered intravenously and sodium citrate (group MC, n = 65). In the second phase, all patients received sodium citrate, and either intravenous administration of ranitidine 50 mg (group RC, n = 50), omeprazole 40 mg (group OC, n = 50), ranitidine 50 mg with metoclopramide 10 mg (group RMC, n = 50) or omeprazole 40 mg with metoclopramide 10 mg (group OMC, n = 49). Gastric contents were aspirated using a 16 FG Salem sump tube and acidity measured with a pH meter. Non-parametric tests were used for comparisons. There was no difference in gastric volume or pH between groups C and MC, or among OC, RC, OMC and RMC. After pooling the data, median (range) gastric volume in groups C and MC (55 (0-360) ml) was greater than in groups OMC and RMC (40 (3-270) ml, p < 0.05). Median (range) pH was lower in groups C and MC (4.97 (0.76-6.99)) than in groups OC, RC, OMC and RMC (5.76 (1.11-7.5), p < 0.001). The proportion of patients with pH < 3.5 and volume > 25 ml in the C and MC groups (43/185) was greater than that in the OC, RC, OMC and RMC groups (18/199, p < 0.001). Ranitidine and omeprazole administered intravenously were equally effective adjuncts to sodium citrate in reducing gastric acidity for emergency Caesarean section. Compared with sodium citrate alone, the addition of either ranitidine, omeprazole or metoclopramide alone did not reduce gastric volume while small reductions in gastric volume were seen with the addition of metoclopramide and either ranitidine or omeprazole.