Intervention Review

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Interventions at caesarean section for reducing the risk of aspiration pneumonitis

  1. Shantini Paranjothy1,*,
  2. James D Griffiths2,
  3. Hannah K Broughton1,
  4. Gillian ML Gyte3,
  5. Heather C Brown4,
  6. Jane Thomas5

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 5 FEB 2014

Assessed as up-to-date: 6 JUN 2013

DOI: 10.1002/14651858.CD004943.pub4


How to Cite

Paranjothy S, Griffiths JD, Broughton HK, Gyte GML, Brown HC, Thomas J. Interventions at caesarean section for reducing the risk of aspiration pneumonitis. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD004943. DOI: 10.1002/14651858.CD004943.pub4.

Author Information

  1. 1

    School of Medicine, Cardiff University, Cochrane Institute of Primary Care and Public Health, Cardiff, UK

  2. 2

    Royal Women's Hospital, Department of Anaesthesia, Parkville, Victoria, Australia

  3. 3

    The University of Liverpool, Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, Liverpool, UK

  4. 4

    Royal Sussex County Hospital, Department of Obstetrics and Gynaecology, Brighton, UK

  5. 5

    The University of Liverpool, C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, Liverpool, UK

*Shantini Paranjothy, Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK. paranjothys@cardiff.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 5 FEB 2014

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[Figure 1]
Figure 1. Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Antacids versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
[Analysis 1.21]
Analysis 1.21. Comparison 1 Antacids versus placebo/no treatment, Outcome 21 Intragastric pH < 2.5 at extubation.
[Analysis 1.23]
Analysis 1.23. Comparison 1 Antacids versus placebo/no treatment, Outcome 23 Gastric volume post intubation (not pre-specified).
[Analysis 1.24]
Analysis 1.24. Comparison 1 Antacids versus placebo/no treatment, Outcome 24 Gastric pH post intubation (not pre-specified).
[Analysis 1.25]
Analysis 1.25. Comparison 1 Antacids versus placebo/no treatment, Outcome 25 At risk of aspiration (not pre-specified).
[Analysis 1.26]
Analysis 1.26. Comparison 1 Antacids versus placebo/no treatment, Outcome 26 Gastric pH at extubation (not pre-specified).
[Analysis 1.27]
Analysis 1.27. Comparison 1 Antacids versus placebo/no treatment, Outcome 27 Gastric volume post intubation > 25 mL (not pre-specified).
[Analysis 2.3]
Analysis 2.3. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
[Analysis 2.4]
Analysis 2.4. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 4 Intragastric volume > 0.4 mL/kg at intubation.
[Analysis 2.21]
Analysis 2.21. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 21 Intragastric pH < 2.5 at extubation.
[Analysis 2.22]
Analysis 2.22. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 22 Intragastric volume > 20 mL at extubation (not pre-specified).
[Analysis 2.23]
Analysis 2.23. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 23 Gastric pH at intubation (not pre-specified).
[Analysis 2.24]
Analysis 2.24. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 24 Gastric pH at extubation (not pre-specified).
[Analysis 2.25]
Analysis 2.25. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 25 At risk of aspiration post intubation (not pre-specified).
[Analysis 2.26]
Analysis 2.26. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 26 At risk of aspiration pre extubation (not pre-specified).
[Analysis 2.27]
Analysis 2.27. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 27 Gastric volume post intubation (not pre-specified).
[Analysis 2.28]
Analysis 2.28. Comparison 2 H2 antagonists versus placebo/no treatment, Outcome 28 Gastric volume pre-extubation (not pre-specified).
[Analysis 3.3]
Analysis 3.3. Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
[Analysis 3.4]
Analysis 3.4. Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 4 Intragastric volume > 0.4 mL/kg at intubation.
[Analysis 3.23]
Analysis 3.23. Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 23 Gastric pH at intubation (not pre-specified).
[Analysis 3.24]
Analysis 3.24. Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 24 At risk of aspiration (not pre-specified).
[Analysis 3.25]
Analysis 3.25. Comparison 3 Proton pump antagonists versus placebo/no treatment, Outcome 25 Gastric volume at intubation (not pre-specified).
[Analysis 4.23]
Analysis 4.23. Comparison 4 Prokinetic drugs versus placebo/no treatment, Outcome 23 At risk of aspiration post intubation (not pre-specified).
[Analysis 4.24]
Analysis 4.24. Comparison 4 Prokinetic drugs versus placebo/no treatment, Outcome 24 At risk of aspiration pre-extubation (not pre-specified).
[Analysis 5.23]
Analysis 5.23. Comparison 5 Non-pharmacological interventions versus placebo/no treatment, Outcome 23 At risk of aspiration (not pre-specified).
[Analysis 6.3]
Analysis 6.3. Comparison 6 Antacids + H2 antagonists versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
[Analysis 6.21]
Analysis 6.21. Comparison 6 Antacids + H2 antagonists versus placebo/no treatment, Outcome 21 Intragastric pH < 2.5 at extubation.
[Analysis 6.23]
Analysis 6.23. Comparison 6 Antacids + H2 antagonists versus placebo/no treatment, Outcome 23 Intragastric pH post intubation (not pre-specified).
[Analysis 6.24]
Analysis 6.24. Comparison 6 Antacids + H2 antagonists versus placebo/no treatment, Outcome 24 Intragastric pH at extubation (not pre-specified).
[Analysis 7.3]
Analysis 7.3. Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 3 Intragastric pH < 2.5 at intubation.
[Analysis 7.23]
Analysis 7.23. Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 23 Risk of aspiration (not pre-specified).
[Analysis 7.24]
Analysis 7.24. Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 24 Gastric pH post intubation (not pre-specified).
[Analysis 7.25]
Analysis 7.25. Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 25 Gastric volume post intubation (not pre-specified).
[Analysis 7.26]
Analysis 7.26. Comparison 7  H2 antagonists + prokinetic drugs versus placebo/no treatment, Outcome 26 Gastric volume < 25 mL after induction.
[Analysis 8.3]
Analysis 8.3. Comparison 8 Antacids versus H2 antagonists, Outcome 3 Intragastric pH < 2.5 at intubation.
[Analysis 8.23]
Analysis 8.23. Comparison 8 Antacids versus H2 antagonists, Outcome 23 At risk of aspiration (not pre-specified).
[Analysis 8.24]
Analysis 8.24. Comparison 8 Antacids versus H2 antagonists, Outcome 24 Gastric volume at intubation (not pre-specified).
[Analysis 8.25]
Analysis 8.25. Comparison 8 Antacids versus H2 antagonists, Outcome 25 Gastric pH at intubation (not pre-specified).
[Analysis 8.26]
Analysis 8.26. Comparison 8 Antacids versus H2 antagonists, Outcome 26 Gastric pH at extubation (not pre-specified).
[Analysis 10.3]
Analysis 10.3. Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 3 Intragastric pH < 2.5 at intubation.
[Analysis 10.4]
Analysis 10.4. Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 4 Intragastric volume < 0.4 mL/kg at intubation.
[Analysis 10.23]
Analysis 10.23. Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 23 At risk of aspiration (not pre-specified).
[Analysis 10.24]
Analysis 10.24. Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 24 Gastric pH post intubation (not pre-specified).
[Analysis 10.25]
Analysis 10.25. Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 25 Gastric volume post intubation (not pre-specified).
[Analysis 10.26]
Analysis 10.26. Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 26 Gastric pH pre extubation (not pre-specified).
[Analysis 10.27]
Analysis 10.27. Comparison 10 H2 antagonists versus proton pump antagonists, Outcome 27 Gastric volume post extubation (not pre-specified).
[Analysis 11.3]
Analysis 11.3. Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 3 Intragastric pH < 2.5 at intubation.
[Analysis 11.21]
Analysis 11.21. Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 21 Intragastric pH < 2.5 at extubation.
[Analysis 11.23]
Analysis 11.23. Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 23 Post Intubation pH (not pre-specified).
[Analysis 11.24]
Analysis 11.24. Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 24 Pre extubation pH (not pre-specified).
[Analysis 11.25]
Analysis 11.25. Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 25 Post intubation gastric volume (not pre-specified).
[Analysis 11.26]
Analysis 11.26. Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 26 Pre-extubation gastric volume (not pre-specified).
[Analysis 11.27]
Analysis 11.27. Comparison 11 Antacids + H2 antagonists versus antacids, Outcome 27 At risk of aspiration (not pre-specified).
[Analysis 13.23]
Analysis 13.23. Comparison 13 Proton pump agonists + prokinetics versus proton pump agonists, Outcome 23 At risk of aspiration post intubation (not pre-specified).
[Analysis 13.24]
Analysis 13.24. Comparison 13 Proton pump agonists + prokinetics versus proton pump agonists, Outcome 24 At risk of aspiration pre extubation (not pre specified).
[Analysis 14.4]
Analysis 14.4. Comparison 14 H2 antagonist versus tramadol, Outcome 4 Intragastric volume > 0.4 mL/kg at intubation.
[Analysis 14.5]
Analysis 14.5. Comparison 14 H2 antagonist versus tramadol, Outcome 5 Nausea.
[Analysis 14.22]
Analysis 14.22. Comparison 14 H2 antagonist versus tramadol, Outcome 22 Intragastric volume > 0.4 mL/kg at extubation.
[Analysis 14.23]
Analysis 14.23. Comparison 14 H2 antagonist versus tramadol, Outcome 23 At risk post intubation (not pre-specified).
[Analysis 14.24]
Analysis 14.24. Comparison 14 H2 antagonist versus tramadol, Outcome 24 At risk pre extubation (not pre-specified).
[Analysis 14.25]
Analysis 14.25. Comparison 14 H2 antagonist versus tramadol, Outcome 25 Nausea 24hours post op (not pre-specified).
[Analysis 15.23]
Analysis 15.23. Comparison 15 Antacids + H2 antagonists versus proton pump antagonists, Outcome 23 At risk of aspiration (not pre-specified).
[Analysis 16.23]
Analysis 16.23. Comparison 16 Proton pump antagonist + antacid versus proton pump antagonist, Outcome 23 Risk of aspiration (not pre-specified).
[Analysis 17.23]
Analysis 17.23. Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 23 Intragastric pH > 2.5 post intubation (not pre-specified).
[Analysis 17.24]
Analysis 17.24. Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 24 Intragastric volume <0.4 mL/kg post intubation (not pre-specified).
[Analysis 17.25]
Analysis 17.25. Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 25 Risk of aspiration (not pre-specified).
[Analysis 17.26]
Analysis 17.26. Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 26 Gastric volume post intubation (not pre-specified).
[Analysis 17.27]
Analysis 17.27. Comparison 17 H2 antagonist + prokinetic versus H2 antagonist, Outcome 27 Gastric pH post intubation (not pre-specified).