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  • Print publication year: 2011
  • Online publication date: December 2011

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

Summary

The prevention and management of postdural puncture headache (PDPH) in the obstetric patient continues to challenge the anesthesiologist. This chapter discusses the clinical management of PDPH in obstetric patients and suggests recommendations based on current, relevant evidence. The presence of focal neurological signs may point toward other neurological problems and prompt further investigations and assessments. The low cerebrospinal fluid (CSF) volume causes a drop in subarachnoid pressure. The incidence of PDPH in obstetric patients is relatively high due to the effects of gender and young adult age. It is also related to the size and design of the needle used and the experience of the anesthesiologist carrying out the procedure. Larger randomized controlled trials may help provide insight into the optimal use of the epidural blood patch (EBP) and other treatments. Such trials will be difficult to perform due to the low incidence of accidental dural puncture (ADP) and PDPH.

Further reading

GyteG M & RichensY. Routine prophylactic drugs in normal labour for reducing gastric aspiration and its effects. Cochrane Database Syst Rev 2006; 3: CD005298.
ParanjothyS, GriffithsJ D, BroughtonH Ket al. Interventions at caesarean section for reducing the risk of aspiration pneumonitis. Cochrane Database Syst Rev 2010; 1: CD004943.

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