Incidence Of Pulmonary Aspiration In Parturients After Cesarean Section With Combined Spinal-epidural Anesthesia

Objective:To estimate the incidence of pulmonary aspiration postoperative of cesarean section with combined use of spinal anaesthesia and epidural anaesthesia in parturients. And analyzes the prognosis and preventing measures of the pulmonary aspiration.Methods:The records of117parturients were reviewed prospectivel. Exclusion criteria: patients presence of cough, leukocytosis and (or) fever preoperative. symptoms including cough, shortness of breath, tightness of the chest and chest X-ray and blood routine examination were recorded first day postoperative. Diagnosis of pulmonary aspiration was based on lung infiltrates on chest X-ray the first day postoperative, supplemented by cough, short of breath, chest tightness and other clinical symptoms and lung auscultation, blood routine examination. pulmonary aspiration was diagnosed by at least one experienced clinicians and one experienced radiologists. Ropivacaine and levobupivacaine were used in anaesthesia. No antiacids or other pharmacological interventions was performed for aspiration prevention excluding fast for8h pre-operative of elective Caesarean section.Results:Eleven cases were diagnosed as pulmonary aspiration and seven cases were diagnosed as suspected aspiration pneumonia in117patients. The incidence of aspiration pneumonia was9.4-15.4%. There are only4cases with symptoms in the11cases of diagnosed pulmonary aspiration:one presence of shortness of breath, fever (39℃) with a few moist rale in lung auscultation, one presence of mild chest discomfort, one presence of mild cough, and the last one presence of only moderate fever (38～38.5℃). There are2cases with symptoms in the7cases of suspected pulmonary aspiration: one presence of mild cough, the other one presence of moderate fever (38～38.5℃). There are1case presence of mild cough in those99cases of normal. There are6cases presence of leukocytosis(WBC>10×109/L and neutrophil ratio>0.7) on the first day in those11cases of diagnosed pulmonary aspiration,3in suspected pulmonary aspiration and41in the normal. Compared with in99cases of normal, the incidence of leukocytosis, leukocyte value and neutrophil ratio first day postoperative in patients diagnosed and suspected pulmonary aspiration cases was not statistically significant. Four in diagnosed and2in suspected pulmonary aspiration cases were accepted bacterial culture, only1in diagnosed cases were positive, and it was the subspecies of non-resistant Klebsiella pneumoniae. The postoperative hospital stay in patients with pulmonary aspiration (6.5±1.8days) was significant longer than those with normal X-ray in lung (4.9±0.4days)(P<0.01), one case with pulmonary aspiration was discharged1week postoperative with still had respiratory symptoms and returned3days after with fever and respiratory symptoms.She was cured1week later. No parturients death.Conclusions:We diagnose pulmonary aspiartion on the basis of X-ray and had a result of incidence of9.4-15.4%in parturients after cesarean section with combined spinal-epidural anesthesia. It’s much higher than some other reports.There was a prolonged postoperative hospital stay in parturients with pulmonary aspiration than in those normal parturients. On the other hand, we need to pay more attention to the prevention of aspiration pneumonia in parturients with cesarean section.