Page 47 - Part 2 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

As with any patient, aspiration is a significant risk for maternal

patients, and normal prohibitions in regard to fasting should
be used whenever possible. Each maternal patient presents a

unique challenge, though, as a predetermined fasting period is
difficult to time as the start of labor and timing of anesthesia is

unpredictable itself. Additionally, labor, a painful and strenuous
process, requires the patient to stay hydrated during the

process. Luckily for the uncomplicated laboring patient, the
intake of moderate amounts of clear liquids may be allowed. The

uncomplicated patient undergoing elective surgery may have
clear liquids up to two hours before induction of anesthesia.

Examples of clear liquids include, but are not limited to, water,
fruit juices without pulp, carbonated beverages, clear tea, black

coffee, and sports drinks. The volume of liquid ingested is less
important than the presence of particulate matter in the liquid

ingested. In the case of laboring patients with additional risk
factors for aspiration (e.g., morbid obesity, diabetes mellitus,

and difficult airway) or patients at increased risk for operative
delivery (e.g., non-reassuring fetal heart rate pattern), the

anesthesiologist and obstetric team should determine further
restrictions of oral intake on a case-by-case basis.

To prevent aspiration, solid foods should be avoided in

laboring patients. The patient undergoing elective surgery
(e.g., scheduled cesarean delivery or postpartum tubal

ligation) should undergo a fasting period for solids of six to
eight hours depending on the type of food ingested (e.g., fat

content). Adherence to the practice guidelines for preoperative
fasting and the use of pharmacologic agents to reduce the

risk of pulmonary aspiration is recommended. Before surgical
procedures (e.g., cesarean delivery or postpartum tubal ligation),

the anesthesiologist should consider the timely administration

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