Lawson Jacob, Howle Ryan, Popivanov Petar, Sidhu Jas, Gordon Camilla, Leong Maria, Onwochei Desire, Desai Neel
Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland.
Br J Anaesth. 2025 Jan;134(1):124-167. doi: 10.1016/j.bja.2024.09.005. Epub 2024 Oct 22.
Delayed gastric emptying increases the risk of pulmonary aspiration during anaesthesia for Caesarean delivery. Our aim in conducting this narrative review was to consider the effect of pregnancy on gastric emptying. The indices of gastric emptying after liquids, solids, or both and when fasted in the various trimesters of pregnancy, at the time of Caesarean delivery, in labour, and the postpartum period were assessed. We considered 32 observational studies, one nonrandomised controlled study, and 22 randomised controlled trials. The evidence indicates that, compared with the nonpregnant state, gastric emptying is decreased in the first but not the second and third trimesters. Before elective Caesarean delivery, carbohydrate drink or tea with milk leads to no difference in gastric cross-sectional area at 2 h relative to fasting or water. Following a standard fast for elective Caesarean delivery, patients may still have high-risk gastric contents. Compared with the nonpregnant state and third trimester, gastric emptying is delayed in labour, although the choice of analgesia has modifying effects. Systemic opioids delay gastric emptying. Epidural analgesia increases gastric emptying, but not back to baseline. Intrathecal analgesia delays gastric emptying relative to epidural analgesia. Women in labour who have eaten solids in the last 8 h still have high-risk gastric contents present in the stomach. The evidence with respect to the postpartum period is conflicting. In conclusion, inconsistencies in the literature reflect the unpredictability of gastric emptying in pregnancy and underline the potential value of gastric ultrasound in women who are pregnant.
剖宫产麻醉期间胃排空延迟会增加肺误吸的风险。我们进行这项叙述性综述的目的是探讨妊娠对胃排空的影响。评估了妊娠各期、剖宫产时、分娩时及产后液体、固体或两者兼有的胃排空指标，以及禁食时的胃排空指标。我们纳入了32项观察性研究、1项非随机对照研究和22项随机对照试验。证据表明，与非妊娠状态相比，妊娠早期胃排空减慢，而妊娠中期和晚期则无此现象。择期剖宫产术前，饮用碳水化合物饮料或奶茶与禁食或饮水相比，2小时时胃横截面积无差异。择期剖宫产标准禁食后，患者胃内仍可能存在高风险的胃内容物。与非妊娠状态及妊娠晚期相比，分娩时胃排空延迟，尽管镇痛方式的选择有调节作用。全身使用阿片类药物会延迟胃排空。硬膜外镇痛可加快胃排空，但未恢复至基线水平。与硬膜外镇痛相比，鞘内镇痛会延迟胃排空。分娩前8小时内进食固体食物的产妇胃内仍存在高风险的胃内容物。关于产后的证据存在矛盾。总之，文献中的不一致反映了妊娠期间胃排空的不可预测性，并突显了超声检查在孕妇中的潜在价值。
