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Treatment of Gastrointestinal Motility Disorders in Pregnancy
- Stephen M. Picca, MD; and
- John Fiordalisi, MD
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TO THE EDITOR:
As anesthesiologists who are constantly faced with the challenge of providing anesthesia for pregnant women, we found the recent review [1] timely and informative. We feel, however, that the section dealing with the risk for aspiration during anesthesia is misleading.
Aspiration of stomach contents during anesthesia is a major cause of morbidity and mortality in pregnant women. The authors conclude that antacids and histamine-2 blockers are the cornerstone of therapy for the prevention of aspiration pneumonitis.
Clinicians should be cautioned that not all antacids are appropriate in this situation. The use of insoluble antacids is contraindicated [2]. These agents, because of their particulate composition, can cause significant and persistent pulmonary damage if aspirated. The drug of choice in this situation is 15 to 30 mL of 0.3 molar solution of sodium citrate. This drug is nonparticulate and results in a less severe pneumonitis, if aspirated. Sodium citrate should be given to all obstetric patients having cesarean section and to those pregnant patients receiving general anesthesia for other types of surgery [3].
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
