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

Yair Binyamin, Sharon Orbach-Zinger, Alexander Ioscovich, Yair Yaish Reina, Yoav Bichovsky, Igor Gruzman, Alexander Zlotnik, Evgeny Brotfain

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Article number101347
JournalAnaesthesia Critical Care and Pain Medicine
Issue number2
StatePublished - 1 Apr 2024
Externally publishedYes


  • Aspiration
  • Cesarean delivery
  • General anesthesia
  • Incidence
  • Pregnancy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine


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