Sodium bicitrate

[lucy07]

Does everyone give bicitra to everyday, garden variety C- sections under spinal? Seems that a large majority of patients puke anyway, and now there is horrible tasting stuff to puke up. I am wondering if the private practice world adheres to this as much as we did in residency....Given that the chance of a high spinal/conversion to GA is pretty low.

What about to patients who claim to have GERD but are asymptomatic and fasting for a GA?

Thanks

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[drmwvr]

Does everyone give bicitra to everyday, garden variety C- sections under spinal? Seems that a large majority of patients puke anyway, and now there is horrible tasting stuff to puke up. I am wondering if the private practice world adheres to this as much as we did in residency....Given that the chance of a high spinal/conversion to GA is pretty low.

What about to patients who claim to have GERD but are asymptomatic and fasting for a GA?

Thanks

We don't see a down side to giving it to the mom you describe. The stakes are higher and GA conversion happens for things other than a high spinal.

Your second patient, for me, doesn't get bicitra if they only get gerd after meals, etoh, whatever. If RSI is indicated to me, they then get the "full court press".

 

[Noyac]

I rarely ever give it to any pts.

 

[Planktonmd]

The whole ritual of the so called aspiration prophylaxis (antacids, metoclopramide, H2 inhibitors, PPI's....) is mostly voodoo and based on academic superstition.
I have senior partners who give that stuff to every patient!
My use of these things has declined over the years and now I decide it on a case by case basis but it's not very common.

 

[Bertelman]

I only give it if it's an urgent section and they have eaten recently. If it's been 8 hrs, I don't give it at all unless they have been vomiting.

There's a few older docs that want to give it every time.

 

[camkiss]

It is a standing order for all of our C-sections. Our variety is grape flavored. I like it because then when the patient pukes it is grape smelling versus plain old bile. 🙂 I also think it is voodoo, but see no real problem with giving it.

 

[proman]

I use it personally. Does that count? The grape flavor is awful, but the plain citrus isn't too bad. It works wonders on my indigestion. And I give to every c/s, +/- on the bad GERDs.

 

[Noyac]

It is a standing order for all of our C-sections. Our variety is grape flavored. I like it because then when the patient pukes it is grape smelling versus plain old bile. 🙂 I also think it is voodoo, but see no real problem with giving it.

Now that is one great use of a drug. I may start using it from time to time for this reason alone.

In the past 4 yrs i have used it about 3 times. Every time it was on myself. Damned red chili and eggs.

 

[eventualeventer]

Purple Gatorade has the same effect. Helps stop the positive feedback loop when you're riding the porcelain bus.

 

[periopdoc]

Now that is one great use of a drug. I may start using it from time to time for this reason alone.

In the past 4 yrs i have used it about 3 times. Every time it was on myself. Damned red chili and eggs.

Is it pathological that I get hungry when you talk about what you are vomiting?

Man I haven't had good red chili and eggs in so long that even the thought of it regurgitated makes my taste buds stand on end. All I find up here in the PacNW is salsa and eggs and people just don't understand that it isn't even close to the real thing.


- pod

 

[periopdoc]

To get back on topic...

Does everyone give bicitra to everyday, garden variety C- sections under spinal? Seems that a large majority of patients puke anyway, and now there is horrible tasting stuff to puke up. I am wondering if the private practice world adheres to this as much as we did in residency....

Of course bicitra is not given to keep you from puking, it is given to neutralize acidic gastric contents so that if you puke and aspirate there won't be so much damage to the lungs.

At least that is how the theory goes.

<zogvoice> I resident therefore all patient get bicitra before c-section and I get pat on head instead of stick on ass. </zogvoice>

Once I am an attending I hope I won't need a pat on the head anymore

-pod