Chapter 17 - Fasting and aspiration prophylaxis in labor and for cesarean section

Summary

Treatment of acid aspiration syndrome (AAS) is mainly supportive and includes initial suctioning of the upper airway after a witnessed aspiration of gastric contents, with intubation and protection of airway as dictated by the patient's ability to adequately protect their airway. It is difficult to accurately estimate the incidence of aspiration in the obstetric patient undergoing a cesarean section under general anesthesia with tracheal intubation. Historically a major concern with fasting of the laboring mother has been that the physical exertion of labor requires a large expenditure of calories. It is widely accepted that the safest and most effective means of aspiration prophylaxis for cesarean section is the use of neuraxial anesthesia. Practice guidelines state that neuraxial techniques are preferred to general anesthesia for most cesarean deliveries. Aspiration prophylaxis for emergency cesarean section is often dictated by the need for rapid induction of anesthesia to facilitate emergency surgical delivery.