Conference ReportHighlights of the 35th Annual Meeting of the Society for Obstetric Anesthesia and PerinatologyMay 14-17, 2003; Phoenix, Arizonafrom Medscape Ob/Gyn & Women's HealthPosted 06/05/2003
"Can I please have something to drink?" Preoperative Intake of Clear Liquids Work presented by Cynthia Wong, MD, and colleagues from Northwestern University in Chicago, Illinois, found that gastric emptying of water was normal in term, obese patients. This is an important finding that supports the recent trend toward liberalization of preoperative intake of clear liquids as well as the allowance of oral clear liquid intake during labor.
Liberalization of previously held strict NPO ("nothing by mouth") policies appears safe and will result in improved patient comfort and satisfaction. The topic of oral intake during labor was also the subject of a Pro-Con debate between Geraldine O'Sullivan, MD, from St. Thomas' Hospital in London, and Samuel Hughes, MD, of the University of San Francisco, California.
Dr. O'Sullivan opined that the stomach of pregnant women is almost always "full" regardless of fasting times, that parturients seldom wish to eat large amounts of solid food in labor anyway, and that gastric emptying appears to be normal in pregnancy and labor, contrary to previously held beliefs.
Thus, she argued that limited amounts of liquids and even soft solids be allowed during labor, as a means of providing comfort and improving metabolic markers related to prolonged food deprivation. Moreover, she argued that maternal deaths related to anesthesia are usually the result of failed attempts to secure the airway, rather than pulmonary aspiration of gastric contents.
By contrast, Dr. Hughes argued that maternal mortality due to all causes, including anesthetic causes, has markedly declined over the past several decades and that clinicians should continue to do everything possible to continue this trend, in the interest of patient safety. He stated that hydration can be achieved with intravenous fluids, and that limitation of oral intake during labor is a small price to pay for improved safety.
Interestingly, a vote of the audience members both before and after the debate indicated a sizable number of converts to the opinion of Dr. O'Sullivan.
