Acid aspiration syndrome prophylaxis in gynaecological and obstetric patients A Norwegian survey

Abstract

Clinical practice and attitudes of Acid Aspiration Syndrome (AAS) prevention in connection with gynaecological and obstetric surgery were surveyed in all Norwegian departments of anaesthesia. General anaesthesia with rapid-sequence intubation using succinylcholine and cricoid pressure was the preferred method for all emergency surgery, except Caesarian section (C-section) where 58% of the departments reported use of spinal or epidural anaesthesia if time allowed for its use. Chemoprophylaxis was more often used before emergency C-section (60%) than before emergency gynaecological surgery (14%), and mostly consisted of the antacid sodium citrate given alone. Seventy-six percent of the departments used mechanical emptying of the stomach before emergency gynaecological surgery and 44% before emergency C-section. While all responders considered recent intake of a "light breakfast" in an elective patient to be a risk factor of AAS indicating delay of surgery or use of specific precautions like regional anaesthesia, rapid-sequence intubation, or chemoprophylaxis, 52-72% of the responders considered obesity, dyspepsia, recent water intake, smoking or use of chewing gum to be risk factors as well. We think this survey demonstrates a need for consensus discussions of AAS prophylaxis.