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Huang S, Cao S, Sun X, Zhang J. Gastric point-of-care ultrasonography in patients undergoing radical gastrointestinal surgery before anesthetic induction: an observational cohort study. BMC Anesthesiol 2024; 24:90. [PMID: 38433227 PMCID: PMC10910806 DOI: 10.1186/s12871-024-02473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Pulmonary aspiration of gastric contents is a serious perioperative complication. Patients with gastric cancer may experience delayed gastric emptying. However, the role of qualitative and quantitative gastric ultrasound assessments in this patient population before anesthesia induction has not yet been determined. METHODS Adult patients with gastrointestinal cancer were recruited and examined using gastric point-of-care ultrasound (POCUS) before anesthetic induction from March 2023 to August 2023 in a tertiary cancer center. Three hundred patients with gastric cancer were conducted with POCUS prior to induction, and three hundred patients with colorectal cancer were included as controls. The cross-sectional area (CSA) of the gastric antrum and gastric volumes (GV) were measured and calculated. We determined the nature of the gastric contents and classified the antrum using a 3-point grading system. A ratio of GV to body weight > 1.5mL/Kg was defined as a high risk of aspiration. RESULTS In patients with gastric cancer, 70 patients were classified as grade 2 (23%, including 6 patients with solid gastric contents) and 63 patients (21%) were identified as having a high risk of aspiration. Whereas in patients with colorectal cancer, only 11 patients were classified as grade 2 (3.7%), and 27 patients (9.7%) were identified as having a high risk of aspiration. A larger tumor size (OR:1.169, 95% CI 1.045-1.307, P = 0.006), tumor located in antrum (OR:2.304, 95% CI 1.169-4.539,P = 0.016), gastrointestinal obstruction (OR:21.633, 95% CI 4.199-111.443, P < 0.0001) and more lymph node metastasis (OR:2.261, 95% CI 1.062-4.812, P = 0.034) were found to be positively while tumor site at cardia (OR:0.096, 95% CI 0.019-0.464, P = 0.004) was negatively associated with high aspiration risk in patients with gastric cancer. CONCLUSION The Gastric POCUS prior to induction provides an assessment of the status of gastric emptying and can identify the patients at high risk of aspiration, especially those with gastric cancer. TRIAL REGISTRATION Chinese Clinical Trial Registry ( www.chictr.org.cn ) identifier: ChiCTR2300069242; registered 10 March 2023.
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Affiliation(s)
- Siming Huang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China
| | - Shumei Cao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China
| | - Xia Sun
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China.
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:171-206. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitari Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology. Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology. Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Bouvet L, Desgranges FP, Barnoud S, Cordoval J, Chassard D. Diagnostic accuracy of a simple qualitative ultrasound assessment for the diagnosis of empty stomach in the adult: A supplementary analysis of a prospective observer-blind randomized crossover study. Acta Anaesthesiol Scand 2023; 67:1202-1209. [PMID: 37325856 DOI: 10.1111/aas.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/16/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND It has been reported that qualitative ultrasound assessment performed in the semi-upright position had high sensitivity to detect gastric fluid volume >1.5 mL.kg-1 . Nevertheless, the diagnostic accuracy of qualitative assessment for the diagnosis of empty stomach (fluid volume <0.8 mL.kg-1 ) has not been assessed. We aimed to assess the diagnostic accuracy of simple qualitative ultrasound assessment with and without head-of-bed elevation to 45° for the diagnosis of an empty stomach. We also aimed to determine the diagnostic accuracy of a composite ultrasound scale and clinical algorithm. METHODS We performed a supplementary analysis of a prospective observer-blind randomized crossover trial in which adult fasting volunteers attended two distinct sessions, with the head-of-bed angled either at 0° or 45°, in a randomized order. Three tests were performed within each session, each corresponding to a different (either 0, 50, 100, 150 or 200 mL) and randomized volume of water; the same volumes were ingested in both sessions, in a randomized order. Ultrasounds were performed 3 min after water ingestion, blindly to the volume ingested. RESULTS We included 20 volunteers in whom 120 measurements were analyzed. The sensitivity and specificity of the qualitative assessment in the semirecumbent position were 93% (95% CI: 68-100) and 89% (95% CI: 76-96), respectively. The composite scale and clinical algorithm did not have better diagnostic accuracy than the qualitative assessment performed with head-of-bed elevation. Without head-of-bed elevation, the clinical algorithm had significantly higher specificity (98% [95% CI: 88-100]) than qualitative assessment (67% [95% CI: 51-80]; p < 0.05). CONCLUSION These results suggest that qualitative assessment in the semirecumbent position had high diagnostic accuracy for the diagnosis of fluid volume <0.8 mL.kg-1 ; this method can be used in clinical practice for reliable diagnosis of empty stomach.
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Affiliation(s)
- Lionel Bouvet
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
- Research Unit APCSe VetAgro Sup UP 2021.A101-University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - François-Pierrick Desgranges
- Research Unit APCSe VetAgro Sup UP 2021.A101-University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
- Department of Anesthesia and Intensive Care, L'Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Sophie Barnoud
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
| | - Julien Cordoval
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
| | - Dominique Chassard
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
- Research Unit APCSe VetAgro Sup UP 2021.A101-University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
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Ge Y, Shen D, Ding Y, Wu K, Zhang Y. Ultrasound assessment of gastric content in patients undergoing laparoscopic cholecystectomy after preoperative oral carbohydrates: a prospective, randomized controlled, double-blind study. Front Surg 2023; 10:1265293. [PMID: 37732164 PMCID: PMC10507388 DOI: 10.3389/fsurg.2023.1265293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background To evaluate the gastric volume and nature after drinking preoperative oral carbohydrates in patients undergoing laparoscopic cholecystectomy via ultrasonography. Methods One hundred patients who had been scheduled for elective laparoscopic cholecystectomy were enrolled and randomized into the traditional fasting group (Control group, n = 50) and the carbohydrate group (CHO group, n = 50). Patients in the Control group fasted solids and drink from midnight, the day before surgery. Patients in the CHO group drank 800 ml and 400 ml of oral carbohydrates 11 and 3 h before surgery, respectively. At 2 h after oral carbohydrates (T1), all patients underwent an ultrasound examination of residual gastric contents; if the patients had a full stomach, the assessment was performed again 1 h later (T2). A stomach containing solid contents or >1.5 ml/kg of liquid was considered "full". The primary outcome was full stomach incidences at the above time points. The secondary outcomes included gastric antral CSA in the right lateral decubitus (RLD) and semi-sitting positions, as well as gastric volume (GV), GV per weight (GV/kg), and Perla's grade at T1. Results Compared with the Control group, the incidence of entire stomach was significantly high in the CHO group 2 h after oral carbohydrates. At the T1 time point, 6 patients (13.3%) in the Control group and 14 patients (30.4%) in the CHO group presented with a full stomach [95% confidence interval (CI), (0.96-5.41), P = 0.049]. At T2, 3 patients (6.7%) in the Control group and 4 patients (8.7%) in the CHO group had a full stomach, with no marked differences between the two groups [95% CI, (0.31-5.50), P = 0.716]. Compared with the Control group, CSA in the semi-sitting and RLD positions, GV and GV/W were significantly high in the CHO group at T1 (P < 0.05). The median (interquartile range) of the Perlas grade was 1 (0-1) in the Control group and 1(1-1.25) in the CHO group (P = 0.004). Conclusion Cholecystectomy patients experience a 2 h delay in gastric emptying after receiving preoperative carbohydrates. In LC patients, the fasting window for oral carbohydrates before surgery should be adequately prolonged. Clinical Trail registration Chinese Clinical Trail Registry, No: ChiCTR2200055245.
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Affiliation(s)
- Yali Ge
- Department of Anesthesiology, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Dejuan Shen
- Department of Ultrasound, Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yinyin Ding
- Department of Anesthesiology, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Keting Wu
- Department of Anesthesiology, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yang Zhang
- Department of Anesthesiology, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
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Bouvet L, Cordoval J, Barnoud S, Berlier J, Desgranges FP, Chassard D. Diagnostic performance of qualitative ultrasound assessment for the interpretation of point-of-care gastric ultrasound to detect high gastric fluid volume: A prospective randomized crossover study. J Clin Anesth 2022; 81:110919. [PMID: 35792453 DOI: 10.1016/j.jclinane.2022.110919] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/14/2022] [Accepted: 06/25/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE This study aimed to assess whether elevating the head of the bed to 45° was associated with sensitivity >90% of the qualitative ultrasound assessment for the diagnosis of gastric fluid volume > 1.5 ml.kg-1. We also assessed the performance of qualitative assessment, composite ultrasound scale, and clinical algorithm, for the diagnosis of fluid volume > 1.5 ml.kg-1 according to whether the head of the bed was elevated to 45° or not. DESIGN Prospective randomized observer-blind crossover trial. SETTING Hospices Civils de Lyon, France. PATIENT Healthy adult volunteers. INTERVENTIONS Two separate study sessions in fasting volunteers: with and without head-of-bed elevation to 45°, in a randomized order. Each session consisted of three tests, each corresponding to a randomized and different volume of water (either 0, 50, 100, 150 or 200 ml); the same volumes were used in both sessions and in a randomized order. Gastric ultrasounds were performed three minutes after the ingestion of water by an investigator blinded to the volume ingested. MEASUREMENTS Diagnostic performance of each approach for the diagnosis of gastric fluid volume > 1.5 ml.kg-1. MAIN RESULTS Twenty volunteers were included, and 120 measurements were analyzed. The sensitivity of the qualitative assessment for the diagnosis of gastric fluid volume > 1.5 ml.kg-1 with and without head-of-bed elevation was 91% (95%CI: 75-98) and 75% (95%CI: 57-89), respectively. The clinical algorithm with head-of-bed elevation had significantly better sensitivity than the qualitative assessment with no head-of-bed elevation; there was no significant difference for other comparisons. CONCLUSIONS The results suggest that qualitative examination of gastric antrum in the supine position with head-of-bed elevation to 45° can discriminate between low and high gastric fluid volume with high sensitivity, while neither the composite ultrasound scale nor the clinical algorithm improved the diagnostic performance of gastric ultrasound for the diagnosis of gastric fluid volume > 1.5 ml.kg-1.
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Affiliation(s)
- Lionel Bouvet
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France; APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.
| | - Julien Cordoval
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France.
| | - Sophie Barnoud
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France
| | - Jean Berlier
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France.
| | - François-Pierrick Desgranges
- APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Anesthesiology and Intensive Care, L'Hôpital Nord-Ouest, Plateau d'Ouilly, 69655 Villefranche-sur-Saône, France
| | - Dominique Chassard
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France; APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.
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Ambulkar R, Manampadi U, Bhosale S, Rana M, Agarwal V, Solanki SL. Pre-induction Ultrasonographic Evaluation of Gastric Residual Volume in Elective Gastrointestinal Cancer Surgeries. Indian J Surg Oncol 2021; 12:841-846. [PMID: 35110912 PMCID: PMC8764019 DOI: 10.1007/s13193-021-01456-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023] Open
Abstract
Pulmonary aspiration of gastric contents during elective surgery remains a major cause of airway-related mortality and morbidity. The preoperative fasting times for solids and liquids have been standardized across various anesthesia society guidelines. Enhanced Recovery After Surgery (ERAS) guidelines now advocate liberal clear fluid intake with carbohydrate loading up to 2 h preoperatively. The aim of the study was to assess whether practicing both ASA fasting guidelines and ERAS protocol makes the patients prone to a full stomach. The supine position standard curvilinear ultrasound probe (2-5 MHz) with Sonosite M-Turbo ©system was used to obtain the images. Gastric residual volume (GRV) was derived from the cross-sectional area (CSA) using the Perlas and colleagues model. A total of 102 patients were recruited and analyzed. The mean age and BMI were 50.65 years ± 13.35 years and 22.23 kg/m2 ± 3.7 kg/m2, respectively. A total of four patients (3.92%) had gastric volume > 1.5 ml/kg; out of these four patients, three were female and one was male. We did not observe any case of pulmonary aspiration in any of our patients. In conclusion, even though for elective surgeries, the current fasting guidelines are adequate, these findings cannot be extrapolated to patients with risk factors for high gastric residual volume where further studies need to be performed.
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Affiliation(s)
- Reshma Ambulkar
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, 2nd Floor Main Building, Dr E Borges Marg, Parel, Mumbai, India
| | - Unnathi Manampadi
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, 2nd Floor Main Building, Dr E Borges Marg, Parel, Mumbai, India
| | - Shilpushp Bhosale
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, 2nd Floor Main Building, Dr E Borges Marg, Parel, Mumbai, India
| | - Meenal Rana
- Department of Anesthesiology & Critical Care, Glenfield Hospital, Leicester, UK
| | - Vandana Agarwal
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, 2nd Floor Main Building, Dr E Borges Marg, Parel, Mumbai, India
| | - Sohan Lal Solanki
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, 2nd Floor Main Building, Dr E Borges Marg, Parel, Mumbai, India
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Evain JN, Durand Z, Dilworth K, Sintzel S, Courvoisier A, Mortamet G, Desgranges FP, Bouvet L, Payen JF. Assessing gastric contents in children before general anesthesia for acute extremity fracture: An ultrasound observational cohort study. J Clin Anesth 2021; 77:110598. [PMID: 34801888 DOI: 10.1016/j.jclinane.2021.110598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE Children with acute extremity fractures are commonly considered to be at risk of pulmonary aspiration of gastric contents during the induction of anesthesia. This study aimed to evaluate the proportion of such children with high-risk gastric contents using preoperative gastric ultrasound. DESIGN Prospective observational cohort study. SETTING Specialist pediatric center over a 30-month period. PATIENTS Children undergoing surgery within 24 h of an acute extremity fracture. INTERVENTIONS None. MEASUREMENTS According to preoperative qualitative and quantitative ultrasound analysis of the antrum in the supine and right lateral decubitus positions, gastric contents were classified as high-risk (clear liquid with calculated gastric fluid volume > 0.8 mL.kg-1, thick liquid, or solid) or low-risk. Factors associated with high-risk gastric contents were identified by multivariable analysis. MAIN RESULTS Forty-one children (37%; 95% CI: 28-47) of the 110 studied (mean(SD) age: 10(3) years) presented with high-risk gastric contents, including 26 (24%; 95% CI: 16-33) with solids/thick liquid contents. Scanning in the supine position alone allowed a diagnosis of high-risk gastric contents in 23 children out of the 63 for whom right lateral decubitus positioning was unfeasible. Gastric contents remained undetermined in 41 children, including one with a non-contributory gastric US (antrum non-visualized). Proximal limb fractures (OR: 2.5; 95% CI: 1.0-6.2), preoperative administration of opioids (OR: 3.9; 95% CI: 1.1-13), and the absence of bowel sounds (OR: 8.0; 95% CI: 1.4-44) were associated with high-risk gastric contents. Performing surgery the day following the trauma was a protective factor (OR: 0.1; 95% CI: 0.0-0.6). No cases of pulmonary aspiration occurred. CONCLUSIONS At least one-third of children with an acute isolated extremity fracture had preoperative gastric contents identified as high risk for pulmonary aspiration. Although preoperative history can guide anesthetic strategy in this population, ultrasound allowed clear stratification of the risk of aspiration in most cases.
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Affiliation(s)
- Jean-Noël Evain
- Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, CS 10217, 38043 Grenoble Cedex 9, France.
| | - Zoé Durand
- Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, CS 10217, 38043 Grenoble Cedex 9, France
| | - Kelly Dilworth
- Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, CS 10217, 38043 Grenoble Cedex 9, France
| | - Sarah Sintzel
- Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, CS 10217, 38043 Grenoble Cedex 9, France
| | - Aurélien Courvoisier
- Department of Pediatric Surgery, Grenoble-Alpes University Hospital, CS 10217, 38043 Grenoble Cedex 9, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, CS 10217, 38043 Grenoble Cedex 9, France
| | - François-Pierrick Desgranges
- Department of Anesthesia, L'Hôpital Nord-Ouest, Villefranche sur Saône Hospital, 69655 Villefranche sur Saône, France
| | - Lionel Bouvet
- Department of Anesthesia and Intensive Care, Hospital Woman Mother Child, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Jean-François Payen
- Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, CS 10217, 38043 Grenoble Cedex 9, France
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Jiang W, Shi L, Zhao Q, Zhang W, Xu M, Wang W, Wang X, Bao H, Leng J, Jiang L. [Ultrasound assessment of gastric insufflation in obese patients receiving transnasal humidified rapid-insufflation ventilatory exchange during general anesthesia induction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1543-1549. [PMID: 33243741 DOI: 10.12122/j.issn.1673-4254.2020.11.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients. METHODS Ninety obese patients (BMI 30-39.9 kg/m2) undergoing laparoscopic cholecystectomy under general anesthesia were randomized into 3 groups (n=30) to receive facemask pre- oxygenation followed by face mask ventilation (FMV) after administration of anesthetics (Group M), oxygenation with THRIVE (Group T), or pre-oxygenation with facemask combined with THRIVE followed continuous oxygenation with both FMV and THRIVE after administration of anesthetics (Group M+T). The patients in the latter two groups received continuous oxygen via THRIVE during tracheal intubation. All the patients received real-time ultrasound monitoring of the gastric antrum, and positive gastric insufflation (GI+) was defined by the presence of comet-tail artifacts. The cross-sectional area of the gastic antrum (CSA-GA) was measured by ultrasound before and after pre-oxygenation and after intubation. The patients' SpO2, PaO2, and PaCO2 at admission (T1), 5 min after pre-oxygenation (T2), 5 min after medication (T3), and immediately after intubation (T4) were recorded, and the incidence of postoperative adverse events was assessed. RESULTS The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T (P < 0.05). The CSA-GA was significantly greater at T4 than at T1 in Group M and Group M+T and in their GI+s ubgroups. The GI+ subgroups in Group M and Group M+ T had significantly larger CSA-GA at T4 than the GI- subgroups (P < 0.05). CSA-GA did not vary significantly during anesthesia induction in Group T (P>0.05). The incidence of grade Ⅰ gastric distension was lower but grade Ⅱ gastric distention was higher in Group M and Group M+T than in Group T (P < 0.05). Group M showed significantly greater variations of PaO2 at T3 and T4 than Group T and Group M+T (P < 0.05). CONCLUSIONS Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.
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Affiliation(s)
- Weiqing Jiang
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Li Shi
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Qian Zhao
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Wenwen Zhang
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Man Xu
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Wanling Wang
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Xiaoliang Wang
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Hongguang Bao
- Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - Jing Leng
- Department of Pathology, Nanjing Medical University, Nanjing 210029, China
| | - Li Jiang
- The Royal Wolverhampton NHS Trust in UK, Wolverhampton, UK
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Sayyadi S, Raoufi M, Arhami Dolatabadi A, Rostami M, Memary E. Ultrasonographic Assessment of Metoclopramide Administration Effectiveness in Accelerating Gastric Emptying Before Urgent Surgery in Patients with Insufficient NPO Time. Anesth Pain Med 2020; 10:e107331. [PMID: 34150570 PMCID: PMC8207850 DOI: 10.5812/aapm.107331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/01/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Aspiration is one of the important complications of general anesthesia, although infrequent as well as accompanying high morbidity and mortality. The volume of gastric content is considered as a risk factor in this regard. Therefore, it is normally mostly recommend to consider proper fasting time before induction of general anesthesia. Objectives This study was conducted to assess the effect of metoclopramide on reducing gastric contents in patients with incomplete fasting before induction of general anesthesia. Methods This quasi-experimental study was conducted on patients with urgent surgical indications with incomplete NPO time. Every other patient received metoclopramide or placebo. Patients in the intervention group received 10 mg (2 ml) of intravenous metoclopramide, and patients in the control group received 2 ml of distilled water as a placebo. Patients in both groups underwent ultrasonography before starting surgery by an expert radiologist to calculate gastric antral grade (GAG) and cross-sectional antral area (CSA). These measurements were then taken for the second time 30 minutes after intervention, before starting the surgery. The values were compared statistically. Results The data of 60 patients were analyzed, of which 30 were in each group. The mean age, body mass index, type of the last consumed food (solid or fluid), NPO time in the two groups were not significantly different (P value > 0.05). The number of patients in the metoclopramide group with higher GAG (P value = 0.001) and the mean CSA (P value = 0.004) before the intervention was more than the control group. The GAG and mean CSA after intervention were not significantly different between the two groups; but the mean difference of decrease in CSA in the metoclopramide group was more than the control group (4.3 vs. 0.99; P value = 0.001), and changes of GAG after intervention to lower levels in the metoclopramide group was more than the control group (P value < 0.05). Conclusions In the current study in which ultrasonographic indexes, including GAG and CSA, were assessed as a suboptimal gastric emptying test method, it was found that metoclopramide could accelerate gastric emptying compared to placebo in patients with incomplete fasting before induction of general anesthesia.
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Affiliation(s)
- Shahram Sayyadi
- Shahid Beheshti Anesthesiology Research Centre, Department of Anesthesiology, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoomeh Raoufi
- Department of Radiology, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Arhami Dolatabadi
- Department of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Rostami
- Shahid Beheshti Anesthesiology Research Centre, Department of Anesthesiology, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Memary
- Shahid Beheshti Anesthesiology Research Centre, Department of Anesthesiology, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Shahid Beheshti Anesthesiology Research Centre, Department of Anesthesiology, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Schwarz SKW, Prabhakar C. What to do when perioperative point-of-care ultrasound shows evidence of a full stomach despite fasting? Can J Anaesth 2020; 67:798-805. [DOI: 10.1007/s12630-020-01669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022] Open
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12
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Jain K, Yadav M, Gupta N, Thulkar S, Bhatnagar S. Ultrasonographic assessment of airway. J Anaesthesiol Clin Pharmacol 2020; 36:5-12. [PMID: 32174650 PMCID: PMC7047677 DOI: 10.4103/joacp.joacp_319_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/04/2019] [Accepted: 05/25/2019] [Indexed: 01/29/2023] Open
Abstract
Ultrasound is gaining increasing popularity among anesthesiologists as it is readily available and provides real-time imaging for various procedures. It is considered as a “visual stethoscope” of the anesthesiologist. After establishing its use in regional blocks and central venous catheter insertion, it is now finding increasing use in anticipation of difficult airway and securing and maintaining it. It has challenged the classical approach of clinical assessment of airway and allows more dynamic bedside assessment. This article attempts to briefly outline the role of ultrasound and its applications for airway management in patients.
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Affiliation(s)
- Kinshuki Jain
- Department of Oncoanaesthesia and Palliative Medicine, Dr. BRAIRCH AIIMS, New Delhi, India
| | - Mukesh Yadav
- Department of Radiology, Dr. BRAIRCH AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Oncoanaesthesia and Palliative Medicine, Dr. BRAIRCH AIIMS, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiology, Dr. BRAIRCH AIIMS, New Delhi, India
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, Dr. BRAIRCH AIIMS, New Delhi, India
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Kruisselbrink R, Gharapetian A, Chaparro LE, Ami N, Richler D, Chan VWS, Perlas A. Diagnostic Accuracy of Point-of-Care Gastric Ultrasound. Anesth Analg 2019; 128:89-95. [DOI: 10.1213/ane.0000000000003372] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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14
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Van de Putte P, Vernieuwe L, Jerjir A, Verschueren L, Tacken M, Perlas A. When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients†. Br J Anaesth 2018; 118:363-371. [PMID: 28203725 DOI: 10.1093/bja/aew435] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 01/17/2023] Open
Abstract
Background Perioperative aspiration leads to significant morbidity and mortality. Point-of-care gastric ultrasound is an emerging tool to assess gastric content at the bedside. Methods We performed a retrospective cohort study of baseline gastric content on fasted elective surgical patients. The primary outcome was the incidence of full stomach (solid content or >1.5 ml kg−1 of clear fluid). Secondary outcomes included: gastric volume distribution (entire cohort, each antral grade); the association between gastric fullness, fasting intervals, and co-morbidities; anaesthetic management changes and incidence of aspiration. Results We identified 538 patients. Thirty-two patients (6.2%) presented with a full stomach. Nine of these (1.7%) had solid content and 23 (4.5%) had clear fluid >1.5 ml kg−1. An empty stomach was documented in 480 (89.8%) patients. The examination was inconclusive in the remaining 20 patients (5.0%). As expected, increasing antral grade was correlated with larger antral cross-sectional area and higher gastric volume (P<0.001). Of the 32 patients with a full stomach, only six had a documented risk factor for prolonged gastric emptying. The anaesthetic management was changed in all nine patients with solid content. No aspiration was reported. Conclusions This retrospective cohort study suggests that a small proportion of elective surgical patients may present with a full stomach despite the recommended duration of fasting. Further research is needed to establish the clinical implications of these findings in the elective setting. At present, the clinical role of gastric ultrasound continues to be for the evaluation of gastric contents to guide management when the risk of aspiration is uncertain or unknown.
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Affiliation(s)
- P Van de Putte
- Department of Anesthesiology, AZ Monica, Campus Deurne, F. Pauwelslei 1, 2100, Deurne, Belgium
| | - L Vernieuwe
- Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium
| | - A Jerjir
- Department of Anaesthesiology, University Hospital Leuven, Leuven, Belgium
| | - L Verschueren
- Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium
| | - M Tacken
- Department of Anaesthesiology, UMC Radboud, Nijmegen, The Netherlands
| | - A Perlas
- Department of Anaesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Ohashi Y, Walker JC, Zhang F, Prindiville FE, Hanrahan JP, Mendelson R, Corcoran T. Preoperative Gastric Residual Volumes in Fasted Patients Measured by Bedside Ultrasound: A Prospective Observational Study. Anaesth Intensive Care 2018; 46:608-613. [DOI: 10.1177/0310057x1804600612] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this prospective observational study was to measure gastric volumes in fasted patients using bedside gastric ultrasound. Patients presenting for non-emergency surgery underwent a gastric antrum assessment, using the two-diameter and free-trace methods to determine antral cross-sectional area. Gastric residual volume (GRV) was calculated using a validated formula. Univariate and multivariable analyses were performed to examine any potential relationships between ‘at risk’ GRVs (>100 ml) and patient factors. Two hundred and twenty-two successful scans were performed; of these 110 patients (49.5%) had an empty stomach, nine patients (4.1%) had a GRV >100 ml, and a further six patients (2.7%) had a GRV >1.5 ml/kg. There was no significant relationship between ‘at risk’ GRV and obesity, diabetes mellitus, gastro-oesophageal reflux disease or opioid use, although our study had insufficient power to exclude an influence of one or more of these factors. Our results indicate that despite compliance with fasting guidelines, a small percentage of patients still have GRVs that pose a pulmonary aspiration risk. Anaesthetists should consider this background incidence when choosing anaesthesia techniques for their patients. While future observational studies are required to determine the role of preoperative bedside gastric ultrasound, it is possible that this technique may assist anaesthetists in identifying patients with ‘at risk’ GRVs.
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Affiliation(s)
- Y. Ohashi
- Department of Anaesthesia and Pain Medicine, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia
| | - J. C. Walker
- Consultant Anaesthetist, Anaesthetic Department, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - F. Zhang
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - F. E. Prindiville
- Sonographer, Department of Imaging Services, Royal Perth Hospital, Perth, Western Australia
| | - J. P. Hanrahan
- General Practitioner, Queens Park Medical Centre, Perth, Western Australia
| | - R. Mendelson
- Emeritus Consultant Radiologist, Department of Diagnostic and Interventional Radiology, Royal Perth Hospital; Clinical Professor, University of Western Australia; Adjunct Professor, Notre Dame University; Perth, Western Australia
| | - T. Corcoran
- Director of Research, Department of Anaesthesia and Pain Medicine, Royal Perth Hospital; Clinical Professor, School of Medicine and Pharmacology, University of Western Australia; Raine Clinical Research Fellow, Raine Foundation/WA Health Department; Adjunct Clinical Professor, School of Public Health and Preventive Medicine, Monash University Australia; Perth, Western Australia
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Galvis-Navarrete SH, Bonilla-Ramírez AJ, Cubillos-Salcedo JE, Quesada-Montealegre DA, Valbuena-Pábon JC. Point-of-care gastric ultrasound in trichobezoar. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Van de Putte P, Perlas A. The link between gastric volume and aspiration risk. In search of the Holy Grail? Anaesthesia 2017; 73:274-279. [DOI: 10.1111/anae.14164] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P. Van de Putte
- Department of Anaesthesiology; AZ Monica, campus Deurne; Deurne Belgium
- Department of Anaesthesiology; UMC Radboud; Nijmegen the Netherlands
| | - A. Perlas
- Department of Anaesthesia and Pain Management; Toronto Western Hospital; University Health Network; University of Toronto; Toronto, ON Canada
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18
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Perlas A, Arzola C, Van de Putte P. Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review. Can J Anaesth 2017; 65:437-448. [DOI: 10.1007/s12630-017-1031-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022] Open
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Chen C, Liu L, Wang CY, Choi SW, Yuen VM. A pilot study of ultrasound evaluation of gastric emptying in patients with end-stage renal failure: a comparison with healthy controls. Anaesthesia 2017; 72:714-718. [PMID: 28332186 DOI: 10.1111/anae.13869] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 01/06/2023]
Abstract
This prospective study was designed to evaluate gastric volume and content in patients with renal failure and healthy controls after an overnight fast, immediately after a light meal and at 6 h after the meal. Thirty subjects in each group were recruited. At each scanning session, gastric antral cross-sectional area was measured in the supine recumbent and right lateral decubitus positions, and a qualitative assessment of gastric contents was made using the Perlas three-point grading system. Six hours after the meal, the mean (SD) antral cross-sectional area in the supine position was 471 (195) mm2 in patients with renal failure and 319 (106) mm2 in healthy controls (p = 0.028), whereas in the right lateral position it was 756 (320) and 521 (180) mm2 , respectively (p = 0.21). In terms of the qualitative assessments of gastric contents, all subjects had an empty stomach after an overnight fast. Five patients with renal failure and no controls had Perlas grade 2 images, indicating significant gastric contents, 6 h after a meal (p = 0.026). This study supports the use of bedside gastric ultrasound as a point-of-care test for patients with known risk factors for delayed gastric emptying.
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Affiliation(s)
- C Chen
- Department of Anaesthesiology, University of Hong Kong Shenzhen Hospital, Hong Kong, China
| | - L Liu
- Department of Radiology, University of Hong Kong Shenzhen Hospital, Hong Kong, China
| | - C Y Wang
- Department of Nephrology, University of Hong Kong Shenzhen Hospital, Hong Kong, China
| | - S-W Choi
- Department of Anaesthesiology, University of Hong Kong, Hong Kong, China
| | - V M Yuen
- Department of Anaesthesiology, University of Hong Kong Shenzhen Hospital, Hong Kong, China
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Zhang CL, Geng CH, Yang ZW, Li YL, Tong LQ, Gao P, Gao YQ. Changes in patients’ symptoms and gastric emptying after Helicobacter pylori treatment. World J Gastroenterol 2016; 22:4585-4593. [PMID: 27182168 PMCID: PMC4858640 DOI: 10.3748/wjg.v22.i18.4585] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 02/29/2016] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the changes in clinical symptoms and gastric emptying and their association in functional dyspepsia (FD) patients.
METHODS: Seventy FD patients were enrolled and divided into 2 groups Helicobacter pylori (H. pylori)-negative group (28 patients), and H. pylori-positive group (42 patients). Patients in the H. pylori-positive group were further randomly divided into groups: H. pylori-treatment group (21 patients) and conventional treatment group (21 patients). Seventy two healthy subjects were selected as the control group. The proximal and distal stomach area was measured by ultrasound immediately after patients took the test meal, and at 20, 40, 60 and 90 min; then, gastric half-emptying time was calculated. The incidence of symptoms and gastric half-emptying time between the FD and control groups were compared. The H. pylori-negative and conventional treatment groups were given conventional treatment: domperidone 0.6 mg/(kg/d) for 1 mo. The H. pylori-treatment group was given H. pylori eradication treatment + conventional treatment: lansoprazole 30 mg once daily, clarithromycin 0.5 g twice daily and amoxicillin 1.0 g twice daily for 1 wk, then domperidone 0.6 mg/(kg/d) for 1 mo. The incidence of symptoms and gastric emptying were compared between the FD and control groups. The relationship between dyspeptic symptoms and gastric half-emptying time in the FD and control groups were analyzed. Then total symptom scores before and after treatment and gastric half-emptying time were compared among the 3 groups.
RESULTS: The incidence of abdominal pain, epigastric burning sensation, abdominal distension, nausea, belching, and early satiety symptoms in the FD group were significantly higher than in the control group (50.0% vs 20.8%; 37.1% vs 12.5%; 78.6% vs 44.4%; 45.7% vs 22.2%; 52.9% vs 15.3%; 57.1% vs 19.4%; all P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the FD group were slower than in the control group (93.7 ± 26.2 vs 72.0 ± 14.3; 102.2 ± 26.4 vs 87.5 ± 18.2; 102.1 ± 28.6 vs 78.3 ± 14.1; all P < 0.05). Abdominal distension, belching and early satiety had an effect on distal gastric half-emptying time (P < 0.05). Abdominal distension and abdominal pain had an effect on the gastric half-emptying time of the whole stomach (P < 0.05). All were risk factors (odds ratio > 1). The total symptom score of the 3 groups after treatment was lower than before treatment (P < 0.05). Total symptom scores after treatment in the H. pylori-treatment group and H. pylori-negative group were lower than in the conventional treatment group (5.15 ± 2.27 vs 7.02 ± 3.04, 4.93 ± 3.22 vs 7.02 ± 3.04, All P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the H. pylori-negative and H. pylori-treatment groups were shorter than in the conventional treatment group (P < 0.05).
CONCLUSION: FD patients have delayed gastric emptying. H. pylori infection treatment helps to improve symptoms of dyspepsia and is a reasonable choice for treatment in clinical practice.
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