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Treatment of Gastrointestinal Motility Disorders in Pregnancy

TO THE EDITOR: As anesthesiologists who are constantly faced with the challenge of providing anesthesia for pregnant women, we found the recent review [1] timely and informative. We feel, however, that the section dealing with the risk for aspiration during anesthesia is misleading. Aspiration of stomach contents during anesthesia is a major cause of morbidity and mortality in pregnant women. The authors conclude that antacids and histamine-2 blockers are the cornerstone of therapy for the prevention of aspiration pneumonitis. Clinicians should be cautioned that not all antacids are appropriate in this situation. The use of insoluble antacids is contraindicated [2]. These agents, because of their particulate composition, can cause significant and persistent pulmonary damage if aspirated. The drug of choice in this situation is 15 to 30 mL of 0.3 molar solution of sodium citrate. This drug is nonparticulate and results in a less severe pneumonitis, if aspirated. Sodium citrate should be given to all obstetric patients having cesarean section and to those pregnant patients receiving general anesthesia for other types of surgery [3].