Incidence and clinical impact of aspiration during cesarean delivery: A multi-center retrospective study.

BACKGROUND: The risk of aspiration during general anesthesia for cesarean delivery has long been thought to be increased due to factors such as increased intra-abdominal pressures and delayed gastric emptying in pregnant patients. However, recent studies have reported normal gastric emptying in pregnant patients, suggesting that the risk of aspiration may not be as high as previously believed. METHODS: We conducted a retrospective study of 48,609 cesarean deliveries, of which 22,690 (46.7%) were performed under general anesthesia at two large tertiary medical centers in Israel. The study aimed to examine the incidence of potentially severe aspiration during cesarean delivery, both under general and neuraxial anesthesia. RESULTS: Among the patients included in the study, three were admitted to the intensive care unit due to suspected pulmonary aspiration. Two of these cases occurred during induction of general anesthesia for emergency cesarean delivery associated with difficult intubation and one under deep sedation during spinal anesthesia. The incidence of aspiration during cesarean delivery during general anesthesia in our study was 1 in 11,345 patients, and the incidence of aspiration during neuraxial anesthesia was 1 in 25,929 patients. No deaths due to aspiration were reported during the study period. CONCLUSIONS: Our findings provide another contemporary analysis of aspiration rates in obstetric patients, highlighting increased risks during the management of difficult airways during general anesthesia and deep sedation associated with neuraxial anesthesia.

The impact of the blood glucose levels of non-diabetic critically ill patients on their clinical outcome.

BACKGROUND: Stress hyperglycaemia is thought to result from a hormonal response (release of catecholamines, glucocorticoids, glucagon, etc.) following stress, sepsis or trauma. Although stress hyperglycaemia is a very common finding in critically ill populations, there are many non-diabetic critically ill patients who do not develop a hyperglycaemic stress response to trauma or acute illness. We suggest that the lack of a hyperglycaemic stress response during the acute phase of a critical illness may correlate significantly with the clinical outcome of these critically ill non-diabetic patients. METHODS: This was a retrospective study of 700 non-diabetic critically ill patients admitted to the general intensive care unit (ICU) at Soroka Medical Center, Beer Sheva, Israel. We analyzed the clinical impact of the blood glucose levels of these patients measured during their first week of ICU hospitalization on their clinical outcome. RESULTS: Age, male gender, and the Acute Physiology and Chronic Health Evaluation (APACHE) score were found to be independent risk factors for new episodes of infection during the patients' stay in the ICU. Age and the APACHE and Sequential Organ Failure Assessment scores were found to be independent risk factors for intra-ICU mortality. In contrast, blood glucose analysis performed during the patients' stay in the ICU was not found to be an independent predictor for new infectious events or for mortality during the ICU stay. CONCLUSION: Our study did not demonstrate an association between blood glucose levels and clinical outcomes in non-diabetic critically ill patients.