ABSTRACT
General anaesthesia predisposes women to gastric acid aspiration. Prevention and management of aspiration are fundamental in reducing deaths associated with aspiration. The dramatic reduction in cases of aspiration since the initiation of the Confidential Enquiries into Maternal Deaths (CEMD) reports has been secondary to changes in prophylactic antacid measures and the increased use of regional anaesthesia. Many investigators have tried to elucidate the true incidence of morbidity and mortality related to aspiration in obstetric anaesthesia. The CEMD triennial reports have shown a steady decline in the numbers of deaths related to pulmonary aspiration, with 18 deaths in 1964–66, 11 deaths in 1976–78, and 1 death each in 1991–93 and 2000–2002. Management of aspiration has been primarily aimed at prevention. This includes fasting patients, pharmacotherapy, physical factors and modulation of the anaesthetic technique. Successive CEMD reports have done much to stimulate improvements in clinical practice that have decreased the incidence of and mortality due to aspiration of gastric contents.
