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Bouvet L, Favre A, Riso A, Fabre J, Zieleskiewicz L, Desgranges FP, Chassard D. Diagnostic accuracy of a simple qualitative ultrasound assessment for the diagnosis of high-risk gastric contents in the parturient. A prospective observational cohort study. J Clin Anesth 2024; 94:111404. [PMID: 38290374 DOI: 10.1016/j.jclinane.2024.111404] [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: 10/03/2023] [Revised: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
STUDY OBJECTIVE Interpretation of gastric ultrasound relies on the use of a clinical algorithm that combines qualitative analysis of the gastric antrum contents with the calculation of the volume of fluid contents. This reference method may be difficult to apply in the parturient. We therefore aimed to assess the diagnostic accuracy of a simple qualitative assessment in the supine position for the diagnosis of high-risk gastric contents in the parturient. We also assessed the diagnostic accuracy of a composite scale and another clinical algorithm based on a mathematical model different to that used in the reference method. DESIGN Prospective observational cohort study. SETTING University hospital, Lyon, France. PATIENTS Adult women admitted to the delivery room. INTERVENTIONS Qualitative and quantitative gastric ultrasound examination within the first hour following admission. MEASUREMENTS With respect to the reference method, the diagnostic accuracy of a simple qualitative assessment for the diagnosis of high-risk gastric contents was assessed. The diagnostic accuracy of a composite scale and another clinical algorithm, and the agreement between each approach were also assessed. MAIN RESULTS A total of 235 parturients were included and analyzed. The simple qualitative assessment led to conclusive ultrasound assessment in 233 (99%) women, while the reference method led to conclusive assessment in 213 (91%) women (P < 0.05). The sensitivity and the specificity of the simple qualitative assessment were 97% (95%CI: 93 to 99%) and 96% (95%CI: 90 to 99%), respectively. These were not significantly different from those of the composite scale and the clinical algorithm. The four approaches showed almost perfect agreement with each other. CONCLUSIONS These results suggest that simple qualitative assessment may be useful in clinical practice to help the anesthesiologist in the assessment of gastric contents status and risk of aspiration.
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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, Bron 69500, France; APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, Villeurbanne 69100, France.
| | - Alix Favre
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France
| | - Alexandre Riso
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France.
| | - Juliette Fabre
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - François-Pierrick Desgranges
- APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, Villeurbanne 69100, France; Department of Anesthesiology and Intensive Care, L'Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche-sur-Saône 69655, France
| | - Dominique Chassard
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France; APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, Villeurbanne 69100, France.
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Perlas A, Arzola C, Portela N, Mitsakakis N, Hayawi L, Van de Putte P. Gastric Volume and Antral Area in the Fasting State: A Meta-analysis of Individual Patient Data. Anesthesiology 2024; 140:991-1001. [PMID: 38241328 DOI: 10.1097/aln.0000000000004914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Pulmonary aspiration of gastric content is a serious anesthetic complication. Gastric point-of-care ultrasound can determine the type and volume of gastric content when clinical information is equivocal. However, a cutoff value of either antral cross-sectional area or volume that may be considered as the upper limit of normal in fasting subjects is still controversial. The aim of this study is to characterize the distribution of baseline antral area and volume in fasting adult subjects and to identify an upper limit (95th percentile) of these distributions. METHODS The authors conducted a meta-analysis of individual participant data of primary studies from an academic research network of investigators collaborating in gastric ultrasound. Studies between January 2009 and December 2020 were included. RESULTS Twelve primary studies met inclusion criteria and were included in the analysis with a sample size of 1,203 subjects. The 95th percentile of area values (measured in the right lateral decubitus) was 9.9 cm2 (95% CI, 9.4 to 10.4), and of volume, 2.3 ml/kg (95% CI, 2.3 to 2.4). In addition, an antrum grade 0 or 1 indicates a 98% probability of an antral area below the 95th percentile. CONCLUSIONS An area of 10 cm2 measured in the right lateral decubitus could be a simple, data-driven upper limit of antral area that could serve as a surrogate of upper limit of normal gastric volume values in fasting adults. These results are limited by the highly selected sampling of the studies included. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Anahi Perlas
- Toronto Western Hospital, University Health Network, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Cristian Arzola
- Sinai Health System, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Natalia Portela
- Mount Sinai hospital, Sinai Health System, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Nicholas Mitsakakis
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lamia Hayawi
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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Kannamani B, Panneerselvam S, Rudingwa P, Badhe AS, Govindaraj K, Ramamoorthy SV. Comparison of ultrasonographic measurement of gastric antral volume and pH with or without pharmacological acid aspiration prophylaxis in low-risk surgical patients - A randomized clinical trial. J Anaesthesiol Clin Pharmacol 2024; 40:299-304. [PMID: 38919423 PMCID: PMC11196045 DOI: 10.4103/joacp.joacp_412_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/27/2024] Open
Abstract
Background and Aims The role of preoperative pharmacological prophylaxis in preventing aspiration pneumonitis under general anesthesia (GA) in patients at low risk of aspiration pneumonitis is still under debate. We addressed the need for routine pharmacological aspiration prophylaxis in at-risk population by assessing the change in gastric volume using ultrasound with and without pharmacological acid aspiration prophylaxis. Material and Methods A single-center, randomized double-blinded trial, with 200 adult patients scheduled for elective surgical procedures under GA, were randomized into a prophylaxis group, in which the patients received oral famotidine and metoclopramide, and a no prophylaxis group, in which the patients did not receive any prophylaxis. Gastric volume derived from preinduction measurement of gastric antral volume by ultrasound, postinduction gastric pH, and incidences of aspiration pneumonitis were compared. Bland-Altman plot was used to determine the level of agreement between measured gastric volume and ultrasonography based on calculated gastric volume. Results The gastric antral cross-sectional area (CSA) and volume in the no prophylaxis group (3.12 cm2 and 20.11 ml, respectively) were comparable to the prophylaxis group (2.56 cm2 and 19.67 ml, respectively) (P-values 0.97 and 0.63, respectively). Although there was a statistically significant decrease in gastric pH in the no prophylaxis group (P-value 0.01), it was not clinically significant to increase the risk of aspiration pneumonitis based on Roberts and Shirley criteria (P-value 0.39). Conclusion In an adequately fasted low-risk population, the amount of residual gastric volume was similar and below the aspiration threshold, regardless of the aspiration prophylaxis status.
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Affiliation(s)
- Balaji Kannamani
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sakthirajan Panneerselvam
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Priya Rudingwa
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ashok S. Badhe
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kirthiha Govindaraj
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Srivats V. Ramamoorthy
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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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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Bouvet L, Fabre J, Roussin C, Nadal C, Dezavelle S, Vial F, Le Gouez A, Soued M, Keita H, Zein W, Desgranges FP, Thuet V, Boucekine M, Duclos G, Leone M, Zieleskiewicz L. Prevalence and factors associated with high-risk gastric contents in women admitted to the maternity unit for childbirth: a prospective multicentre cohort study. Br J Anaesth 2024; 132:553-561. [PMID: 38177007 DOI: 10.1016/j.bja.2023.11.043] [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: 05/16/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND This multicentre prospective observational study sought to determine the prevalence and the factors associated with high-risk gastric contents in women admitted to the maternity unit for childbirth, and to identify the clinical situations in which ultrasound assessment of gastric contents would be most helpful (i.e. when the prevalence of high-risk gastric contents is close to 50%). METHODS Ultrasound assessments of gastric contents were performed within the first hour after admission to the maternity unit. The prevalence of high-risk gastric contents was calculated and variables associated with high-risk gastric contents were identified using logistic regression analyses. RESULTS A total of 1003 parturients were analysed. The prevalence of high-risk gastric contents was 70% (379/544; 95% confidence interval: 66-74%) in women admitted in spontaneous labour and 65% (646/1003; 95% confidence interval: 61-67%) in the whole cohort. Lower gestational age, increased fasting duration for solids, and elective Caesarean delivery were independently associated with reduced likelihood of high-risk gastric contents. In women admitted in spontaneous labour and in the whole cohort, the prevalence of high-risk gastric contents ranged from 85% to 86% for fasting duration for solids <6 h, 63%-68% for fasting 6-8 h, 54%-55% for fasting 8-12 h, and 47%-51% for fasting ≥12 h. CONCLUSIONS Around two-thirds of parturients had high-risk gastric contents within the first hour after admission to the maternity unit. Our results suggest that gastric emptying for solids continues in labouring women, and that gastric ultrasound would be most helpful when fasting duration is ≥8 h.
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Affiliation(s)
- Lionel Bouvet
- Department of Anaesthesiology 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.
| | - Juliette Fabre
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
| | - Charlotte Roussin
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Camille Nadal
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Sylvain Dezavelle
- Department of Anaesthesiology and Intensive Care, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Mickael Soued
- Department of Anaesthesiology and Intensive Care, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Hawa Keita
- Department of Anaesthesiology and Intensive Care, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Waed Zein
- Department of Anaesthesiology and Intensive Care, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - François-Pierrick Desgranges
- Research Unit APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France; Department of Anaesthesiology and Intensive Care, L'Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Vincent Thuet
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mohamed Boucekine
- Department of Biostatistics, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Gary Duclos
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Marc Leone
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Rousset J, Derely J, LE Guen M, Soued M, Fischler M, Mercier FJ, Vallee A, LE Gouez A. An observational study of gastric content in women scheduled for cesarean section or operative hysteroscopy. Minerva Anestesiol 2023; 89:1065-1073. [PMID: 37768703 DOI: 10.23736/s0375-9393.23.17434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND The estimation of gastric content in third trimester pregnant women has already been studied, conclusions remain contradictory. The aim of this study was to compare gastric content in pregnant and non-pregnant women using gastric ultrasound. We performed an observational two-center study of women scheduled for a cesarean section (CS group) and of non-pregnant women scheduled for hysteroscopy (HS group). METHODS Ultrasound evaluation was performed before surgery with measurement of antral cross-sectional area (CSA) in the semi-recumbent position (SRP), primary outcome, and in the right lateral position (RLD). Gastric fluid volume (GFV) was calculated. Results are expressed as medians (25th and 75th percentiles). Perlas Score was evaluated and expressed as number (percentage). RESULTS Sixty patients in the CS group and 64 in the HS group were analyzed. Antral CSA (SRP) was greater in the CS group (350 mm2 [236-415] vs. 247 mm2 [180-318]; P=0.001). Antral CSA (RLD) was also significantly greater in the CS group (P=0.027). GFV was not different between groups whether expressed in absolute value (P=0.516) or relative to weight (P=0.946) mL.kg-1. Perlas Score repartition was similar in both groups (P=0.860). Kappa coefficients of concordance between CSA, GFV and Perlas Score were slight or at best fair. CONCLUSIONS Our study confirmed that antral CSA is increased among pregnant women and outlined that antral CSA should not be used alone in the decision-making process especially when the results of indicators (antral CSA, GFV, and Perlas Grading Score) are discordant.
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Affiliation(s)
- Julien Rousset
- Service of Anesthesiology, Department of Anesthesiology, Foch Hospital, Suresnes, France -
- Paris-Saclay University, Gif-sur-Yvette, France -
| | - Jean Derely
- Paris-Saclay University, Gif-sur-Yvette, France
- Department of Anesthesiology and Intensive Care, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Clamart, France
| | - Morgan LE Guen
- Service of Anesthesiology, Department of Anesthesiology, Foch Hospital, Suresnes, France
- Paris-Saclay University, Gif-sur-Yvette, France
| | - Mickaël Soued
- Paris-Saclay University, Gif-sur-Yvette, France
- Department of Anesthesiology and Intensive Care, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Clamart, France
| | - Marc Fischler
- Service of Anesthesiology, Department of Anesthesiology, Foch Hospital, Suresnes, France
- Paris-Saclay University, Gif-sur-Yvette, France
| | - Frédéric J Mercier
- Paris-Saclay University, Gif-sur-Yvette, France
- Department of Anesthesiology and Intensive Care, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Clamart, France
| | - Alexandre Vallee
- Department of Epidemiology, Data, and Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | - Agnes LE Gouez
- Paris-Saclay University, Gif-sur-Yvette, France
- Department of Anesthesiology and Intensive Care, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Clamart, France
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Liu J, Dong S, Li W, Yu X, Huang S. Effect of early oral carbohydrate intake after elective Cesarean delivery on maternal body temperature and satisfaction: a randomized controlled trial. Can J Anaesth 2023; 70:1623-1634. [PMID: 37715046 DOI: 10.1007/s12630-023-02564-6] [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: 11/15/2022] [Revised: 02/14/2023] [Accepted: 03/11/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE Although the Enhanced Recovery After Cesarean Delivery (ERAC) consensus statement provides recommendations for early postoperative drinking and eating, evidence from high-quality clinical research directly addressing parturients is sparse. Our objective was to assess if early oral carbohydrate intake after elective Cesarean delivery improves maternal recovery. METHODS In this randomized controlled trial, we enrolled parturients undergoing elective Cesarean delivery under spinal anesthesia with tympanic membrane temperatures ≤ 36.5 °C immediately upon arrival at the postanesthesia care unit. Parturients were randomized to either 100 mL of oral complex carbohydrate intake (group CC) or 10 mL of water (group C). The primary outcome was maternal tympanic membrane temperature. Other outcomes included maternal thermal comfort score, degree of shivering, satisfaction, degree of thirst and hunger, and gastric emptying assessed by ultrasonography. RESULTS We included 90 participants in the final analysis. The mean (standard deviation [SD]) maternal body temperature at 120 min after ingestion was 36.7 (0.3) °C in group CC and 36.6 (0.3) °C in group C (difference in means, 0.14 °C; 95% confidence interval, 0.02 to 0.26; P = 0.02). Furthermore, using repeated measure models, the linear trends of temperature changes over time between groups CC and C were significantly different (P = 0.04). The thermal comfort scores at 120 min after ingestion were higher in group CC than in group C (P = 0.02), and the linear trends of shivering score changes over time between groups CC and C also were different (P = 0.003). The mean (SD) visual analogue scale scores for maternal satisfaction were 84 (13) mm in group CC and 47 (20) mm in group C (P < 0.001). Nevertheless, at 90 and 120 min after ingestion, there were no differences between the two groups in the number of participants with a gastric antrum cross-sectional area > 10.3 cm2. CONCLUSIONS Early oral carbohydrate intake after Cesarean delivery helped to restore maternal body temperature postoperatively and improve maternal satisfaction. Nevertheless, the clinical importance of these finding is unclear, given that most of the differences were small. In addition, there was no delay in maternal gastric emptying after consumption of a complex carbohydrate beverage in the early post-Cesarean period. STUDY REGISTRATION www.chictr.org.cn (ChiCTR2000031085); first submitted 13 November 2022.
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Affiliation(s)
- Jingjing Liu
- Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China
| | - Sulin Dong
- Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China
| | - Weiyi Li
- Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China
| | - Xinhua Yu
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Shaoqiang Huang
- Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China.
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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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Giron Arango L, Perlas A. Gastric point-of-care ultrasound: a diagnostic tool that is coming of age? Can J Anaesth 2023; 70:1291-1294. [PMID: 37380902 DOI: 10.1007/s12630-023-02524-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Laura Giron Arango
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Anahi Perlas
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
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10
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Zhou S, Cao X, Zhou Y, Xu Z, Liu Z. Ultrasound Assessment of Gastric Volume in Parturients After High-Flow Nasal Oxygen Therapy. Anesth Analg 2023; 137:176-181. [PMID: 36630297 DOI: 10.1213/ane.0000000000006340] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND High-flow nasal oxygen (HFNO) therapy is widely used in critical care obstetrics to improve oxygenation. Much of the benefit of HFNO is linked to the creation of modest levels of positive airway pressure. Pregnant women are generally considered to be at high risk of regurgitation and aspiration. It is unknown whether HFNO may cause gas insufflation into the stomach and further increase this risk. Therefore, this study aimed to systematically evaluate the possible safety effects of HFNO on gastric volume in healthy fasted parturients. METHODS Sixty fasted parturients scheduled for elective cesarean delivery were enrolled in an observer-blinded, prospective, interventional study. We used ultrasonography to assess changes of antral cross-sectional area (CSA) and gastric volume before and after a 20-minute treatment with HFNO at a rate of 50 L·min -1 . The primary outcome was the change in gastric volume from before to after HFNO therapy, and the secondary outcome was the distribution of antral grades. RESULTS In semirecumbent right lateral position, the antral CSA at baseline and after treatment with HFNO was 3.81 (3.01-4.72) cm 2 and 3.79 (3.03-4.54) cm 2 , respectively. The estimated fluid volume at baseline and after treatment with HFNO was 38.51 (33.39-54.62) mL and 39.71 (32.00-52.82) mL, respectively. All participants had either a grade 0 or grade 1 antrum, and most of them had a grade 0 antrum. There was no significant difference in gastric volume and distribution of antral grades before and after HFNO therapy. Gastric air distension was not shown in any of the parturients either at baseline or after treatment with HFNO. CONCLUSIONS Treatment with HFNO for 20 minutes at flow rates up to 50 L·min -1 did not increase gastric volume in term pregnant women breathing spontaneously when evaluated by gastric ultrasonography.
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Affiliation(s)
- Shuangqiong Zhou
- From the Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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11
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Chaitra T, Palta S, Saroa R, Jindal S, Jain A. Assessment of residual gastric volume using point-of-care ultrasonography in adult patients who underwent elective surgery. Ultrasound J 2023; 15:7. [PMID: 36752856 PMCID: PMC9908785 DOI: 10.1186/s13089-023-00307-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Aspiration pneumonitis remains a dreaded complication that may lead to almost 9% of anaesthesia-related deaths. The presence of gastric contents has always been a contributing factor to an increased risk of aspiration. Preoperative gastric ultrasound has been suggested as a modality for determining residual volume in special populations and conditions. We conducted an observational study to determine the gastric residual volume in preoperative patients of elective surgery with gastric ultrasound and to study its correlation with patient factors. METHODS We enrolled 411 patients in the age group of 18-80 with ASA-PS I and II having BMI less than 35 kg/m2. Patients with prior gastrointestinal surgery and parturients were excluded from the present study. Gastric antrum in both supine and right lateral decubitus positions was measured using USG in the immediate preoperative period, and gastric residual volume was calculated, which was subsequently correlated with various patient factors. RESULTS On qualitative assessment, 97 and 118 patients were observed to have distended stomachs in the supine and right lateral decubitus positions, respectively. On quantitative assessment, 336 had safe GRV, 60 patients were classified as having a low risk of aspiration (GRV < 1.5 ml/kg) while 13 had a high risk of aspiration (> 1.5 ml/kg). Eight patients with a fasting duration of more than ten hours and five who fasted between 6 and 10 h had a gastric residual volume of more than 1.5 ml/h. Patients who were premedicated with histamine blockers had a statistically significant higher antral cross-sectional area (p-value - 0.022*) and GRV (p-value - 0.018*) in the right lateral decubitus position compared to patients who had taken proton pump inhibitors (PPIs). As BMI increased, there was a statistically significant (p-value < 0.001) increase in mean antral CSA in both supine and right lateral decubitus positions. There was a statistically significant association found between type 2 diabetes (p-value 0.045*) with antral grade. DISCUSSION Patients can have significant residual volume (> 1.5 ml/kg) despite adequate fasting, and preoperative gastric ultrasound can help in assessing the same and guiding perioperative airway management. PPIs are more effective in reducing gastric residual volume as compared to histamine blockers. Patients with a BMI of more than 30 and type 2 diabetes mellitus have significant correlation with increased gastric residual volume mandating preoperative gastric ultrasound assessment for effective management. CONCLUSIONS Patients with BMI over 30 and type 2 diabetes may benefit from POCGUS to guide perioperative airway management by stratifying GRV. Trial registration Name of registry-Clinical Trial Registry of India. Trial registration number-2020/03/024083. Date of registration-19.3.2020. URL- http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=39961&EncHid=&userName=.
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Affiliation(s)
- T.S. Chaitra
- grid.416286.f0000 0004 1793 9129Department of Anaesthesia, Sri Siddhartha Medical College Hospital and Research Centre, Tumkur, India
| | - Sanjeev Palta
- grid.413220.60000 0004 1767 2831Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India
| | - Richa Saroa
- grid.413220.60000 0004 1767 2831Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India
| | - Swati Jindal
- grid.413220.60000 0004 1767 2831Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India
| | - Aditi Jain
- Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India.
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To Eat or Not to Eat? A Review of Current Practices Regarding Food in Labor. CURRENT ANESTHESIOLOGY REPORTS 2023. [DOI: 10.1007/s40140-023-00549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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13
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Gunasekaran A, Govindaraj K, Gupta SL, Vinayagam S, Mishra SK. Comparison of Gastric Insufflation Volume Between Ambu AuraGain and ProSeal Laryngeal Mask Airway Using Ultrasonography in Patients Undergoing General Anesthesia: A Randomized Controlled Trial. Cureus 2022; 14:e27888. [PMID: 36110490 PMCID: PMC9464011 DOI: 10.7759/cureus.27888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Ambu AuraGain and ProSeal laryngeal mask airway are second-generation supraglottic airway devices (SADs) with added advantage of gastric drain and better oropharyngeal sealing pressure. The primary objective was to study the difference in the gastric insufflation volume between Ambu AuraGain and ProSeal LMA in patients undergoing general anesthesia. Methods: This randomized controlled trial involving 120 adult patients scheduled under general anesthesia were randomized into either Ambu AuraGain or LMA ProSeal group. Gastric cross-sectional area was measured using ultrasonography at baseline, after mask ventilation, and at the end of surgery. Gastric volume was calculated from the measured cross-sectional area. Oropharyngeal sealing pressure, peak airway pressure, and postoperative complications were noted. Statistical analysis was done using SPSS version 22 (Armonk, NY: IBM Corp.) and p < 0.05 was considered statistically significant. Results: Demographic profile of the study groups was comparable. There was a significant difference in gastric volume between the groups at the end of surgery with 5.91 ml (±9.68 ml) in Ambu AuraGain group and 12.28 ml (±13.05 ml) in the LMA ProSeal group (p = 0.001). Similarly, there was a difference in volume between baseline and at the end of the surgery within the groups also (Ambu AuraGain group, p=0.0012; LMA ProSeal group, p=0.0015, respectively). Though the oropharyngeal sealing pressure and peak airway pressures were comparable, increased incidence of postoperative complications was observed with LMA ProSeal. Conclusion: Thus, Ambu AuraGain resulted in a lower gastric insufflation volume than LMA ProSeal with lesser incidence of postoperative complications.
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Chang XY, Wang LZ, Xia F, Zhang YF. Prevalence of risk stomach in laboring women allowed to unrestrictive oral intake: a comparative cross-sectional study. BMC Anesthesiol 2022; 22:41. [PMID: 35130855 PMCID: PMC8819948 DOI: 10.1186/s12871-022-01582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Although restricting food intake during labor is recommended by guidelines, intrapartum starvation has not been popular in some regions. We conducted this comparative cross-sectional study to determine the prevalence of risk stomach in non-fasted laboring women compared with fasted non-laboring women using gastric ultrasound. Methods Ultrasound examination of the antrum was performed in 50 term fasted non-laboring women before elective cesarean delivery and 50 laboring women allowed to eat and drink during active labor. Examinations consisted of the qualitative (antral grades, 0–3) and quantitative evaluation (antral cross-sectional area and calculated gastric volume) in the supine and right lateral decubitus (RLD) position. A risk stomach was defined as an antral grade ≥ 2 or grade 1 with gastric volume ≥ 1.5 ml· kg− 1. Results No non-laboring women had grade ≥ 2, while 34 (68%) laboring women had grade ≥ 2. Nine (18%) non-laboring and 40 (80%) laboring women presented risk stomach (P < 0.001) (risk ratio: 4.4, 95% CI 2.4–8.2). Compared with non-laboring women, laboring women had larger antral area at “empty” stomach (grade 0) (437 mm2 vs.350 mm2 in supine, 571 mm2 vs.480 mm2 in RLD, P < 0.05) and cut-off values of antral area to discriminate a risk stomach (510 mm2 vs. 453 mm2 in supine, 670 mm2 vs. 605 mm2 in RLD). Conclusions This study confirms a higher prevalence of risk stomach presents in laboring women under a liberal eating policy, gastric ultrasound is therefore useful for this risk population if general anesthesia is required unexpectedly.
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Affiliation(s)
- Xiang-Yang Chang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Li-Zhong Wang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, 314000, Zhejiang, China.
| | - Feng Xia
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Yin-Fa Zhang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, 314000, Zhejiang, China
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15
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Fiszer E, Aptekman B, Baar Y, Weiniger CF. The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: A double-blinded randomised controlled trial. Eur J Anaesthesiol 2022; 39:50-57. [PMID: 33852498 DOI: 10.1097/eja.0000000000001514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidural fentanyl doses above 100 μg have been shown, using the paracetamol absorption test, to reduce gastric emptying in fasted labouring women. OBJECTIVE To investigate the effect of fentanyl dose on gastric emptying in nonfasted labouring women using gastric ultrasonography. DESIGN A double-blinded randomised controlled study. SETTING A tertiary medical centre in Tel Aviv, Israel between 30 July 2020 and 11 October 2020. PATIENTS Eighty labouring women with cervical dilation 5 cm or less, at least 18 years age, at least 37 weeks gestation with a singleton pregnancy and cephalad foetus. INTERVENTIONS Women randomised to high (>100 μg) or low (<100 μg) cumulative epidural fentanyl had ultrasound gastric content assessment, measuring antral cross-sectional area (CSA) at epidural placement and 2 h thereafter (T2 h). MAIN OUTCOME MEASURES The primary outcome was CSA at T2 h comparing high-dose versus low-dose fentanyl. Secondary outcomes included change in CSA between baseline and T2 h. Sub-group analysis compared stomach content at T2 h according to baseline stomach content, empty (CSA <381 mm2) or full (CSA ≥381 mm2), and high-dose versus low-dose fentanyl. RESULTS Data from 80 women were analysed; 63 had empty and 17 had full stomach at baseline. There was no significant difference in CSA at T2 h between high-dose, mean 335 ± SD 133 mm2, versus low-dose fentanyl, mean 335 ± SD 172 mm2, P = 0.991. Change in CSA baseline to T2 h was 46 ± SD 149 mm2 for high and 49 ± SD 163 mm2 for low-dose group, P = 0.931. The subgroup analysis according to baseline stomach content showed no statistically significant differences in CSA at T2 h. CONCLUSION The CSA at T2 h was similar for women who received high-dose versus low-dose epidural fentanyl, measured by ultrasound, in our nonfasted labouring cohort. TRIAL REGISTRATION Clinicaltrials.gov number: NCT04202887.
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Affiliation(s)
- Elisheva Fiszer
- From the Department of Anaesthesia, Intensive Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (EF, BA, YB, CFW)
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Sarhan K, Hasanin A, Melad R, Fouad R, Elhadi H, Elsherbeeny M, Arafa A, Mostafa M. Evaluation of gastric contents using ultrasound in full-term pregnant women fasted for 8 h: a prospective observational study. J Anesth 2021; 36:137-142. [PMID: 34773139 DOI: 10.1007/s00540-021-03019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to evaluate the gastric volume and contents after an 8-h fasting period in full-term, non-laboring, pregnant women following a standardized meal. METHODS In this prospective observational study, we included full-term pregnant women scheduled for elective cesarean delivery. The participants were instructed to fast after a standardized meal (apple juice, bread, and cheese). Participants were scanned in the semi-recumbent and right-lateral positions 8 h after the standardized meal. The primary outcome was the proportion of patients with gastric volume > 1.5 mL kg-1 calculated by two equations. Secondary outcomes included the antral cross-sectional area and gastric volume. Data are expressed as frequency (%, 95% confidence interval [CI]), mean ± standard deviation (95% CI of the mean), or median (quartiles) as appropriate. RESULTS Forty-one women were available for the final analysis. For the primary outcome, one participant (2.4%, 95% CI of 0.06 to 12.8%) had gastric volume > 1.5 mL kg-1, and none had solids in the antrum. For the secondary outcomes, the mean (95% CI of the mean) of the antral cross-sectional area was 2.11 ± 0.72 (1.88 to 2.34) cm2 and 4.08 ± 1.80 (3.51 to 4.65) cm2 during the semi-recumbent and right-lateral position, respectively. The median (quartiles) gastric volume was 0.53 (0.32, 0.66) mL kg-1 and 0.33 (0.13, 0.52) mL kg-1 as estimated by Perlas et al. and Roukhomovsky et al. equations, respectively. CONCLUSION After 8-h fasting following a standardized meal, full-term pregnant non-laboring women are less likely to have a high residual gastric volume.
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Affiliation(s)
- Khaled Sarhan
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Ramy Melad
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Reham Fouad
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hany Elhadi
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Mona Elsherbeeny
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Amany Arafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt.
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Sherwin M, Katz D. Using gastric ultrasound to assess gastric content in the pregnant patient. BJA Educ 2021; 21:404-407. [PMID: 34707884 DOI: 10.1016/j.bjae.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- M Sherwin
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - D Katz
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Jeong JY, Ahn JH, Shim JG, Lee SH, Ryu KH, Lee SH, Cho EA. Gastric emptying of preoperative carbohydrate in elderly assessed using gastric ultrasonography: A randomized controlled study. Medicine (Baltimore) 2021; 100:e27242. [PMID: 34664868 PMCID: PMC8448003 DOI: 10.1097/md.0000000000027242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Preoperative carbohydrate loading enhances postoperative recovery and reduces patient discomfort. However, gastric emptying of liquids can be delayed in elderly populations. Therefore, this study aimed to evaluate the gastric emptying of 400 mL of a carbohydrate drink ingested 2 hours before surgery in elderly patients. METHODS In this prospective, randomized controlled study, patients aged >65 years were allocated to either fast from midnight (nil per os [NPO] group, n = 29) or drink 400 mL of a carbohydrate drink 2 hours before surgery (carbohydrate group, n = 29). The gastric antrum was assessed using ultrasonography in the supine position, followed by the right lateral decubitus (RLD) position. The gastric antrum was graded as grade 0 (fluid not seen in both positions), grade 1 (fluid only seen in the RLD position), and grade 2 (fluid seen in both positions). The gastric antral cross-sectional area (CSA) and aspirated residual gastric volume were measured. RESULTS In 58 patients, the incidence of grade 2 stomach was 13.8% in NPO group and 17.2% in carbohydrate group (P = .790). The gastric antral CSA in the supine position was larger in carbohydrate group than in NPO group (4.42 [3.72-5.18] cm2 vs 5.31 [4.35-6.92] cm2, P = .018). The gastric antral CSA in the RLD position was not different in NPO and carbohydrate groups (P = .120). There was no difference in gastric volume (2 [0-7.5] vs 3 [0-13.4], P = .331) in NPO group versus carbohydrate group. CONCLUSION The incidence of grade 2 stomach was not different between NPO group and carbohydrate group in elderly patients.
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Affiliation(s)
- Jae Yong Jeong
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hee Ahn
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Geum Shim
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Hyun Lee
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Ho Ryu
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Lee
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Ah Cho
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Shorbagy MS, Kasem AA, Gamal Eldin AA, Mahrose R. Routine point-of-care ultrasound (POCUS) assessment of gastric antral content in traumatic emergency surgical patients for prevention of aspiration pneumonitis: an observational clinical trial. BMC Anesthesiol 2021; 21:140. [PMID: 33964867 PMCID: PMC8106174 DOI: 10.1186/s12871-021-01357-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Polytrauma patients are at a higher risk of delayed gastric emptying. To assess the gastric volume, a reliable diagnostic tool is needed to prevent the occurrence of aspiration pneumonia, which remains a serious complication associated with anesthesia. Gastric antral ultrasound can provide reliable information about the size of the gastric antrum in traumatized patients undergoing emergency surgery. METHODS A prospective observational study of 45 polytrauma patients undergoing emergency surgery under general anesthesia was carried out. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed for qualitative and quantitative assessment of the gastric antrum in a supine position and right lateral decubitus (RLD) position. This was followed by routine placement of the nasogastric tube to aspirate and calculate the volume of the stomach contents. RESULTS Of the 45 polytrauma patients, the risk assessment of aspiration and the anesthesia technique changed in 14 patients (31.1%) after the gastric ultrasound examination. A very good relationship existed between the expected stomach volume at the RLD position and the suction volume in the nasogastric tube. In all cases, no aspirations were documented. CONCLUSION Ultrasound examination of the stomach in polytrauma patients allows assessing the size and type of stomach contents. The data obtained can influence the choice of anesthesia technique and reduce the risk of aspiration pneumonia. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov . registry number: NCT04083677 on September 6, 2019.
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Affiliation(s)
- Mohamed S Shorbagy
- Anesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr A Kasem
- Anesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed A Gamal Eldin
- Diagnostic and Interventional Radiology Atomic Energy Authority, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramy Mahrose
- Anesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Abstract
BACKGROUND Obstetric anaesthesia has been associated with concern for the inhalation of gastric contents for many years, justifying fasting during labour. However, many anaesthesiologists and obstetricians now allow fluid intake during labour. OBJECTIVE(S) We hypothesised that allowing oral fluid intake during labour is not associated with increased gastric contents. We used ultrasound assessment of gastric contents to evaluate this hypothesis. DESIGN A randomised, single-blind and intention-to-treat noninferiority trial comparing antral area measured by ultrasound in fasting parturients and in those who were allowed to drink fluid for 90 min after randomisation. SETTING Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. PATIENTS Pregnant women, aged from 18 to 40 years and from week 36 of an uncomplicated singleton gestation, were randomised into a fasting group and a fluid intake group after admission to the delivery room. Of the 184 patients screened, data from 125 were analysed: fasting group (62), fluid intake group (63). INTERVENTION Women in the fluid intake group were allowed to drink up to 400 ml of apple juice for 90 min after randomisation. MAIN OUTCOME MEASURE We compared the percentage of women with an 'empty stomach' between the two groups: empty stomach was defined as an antral cross-sectional area (CSA) less than 300 mm assessed in a semirecumbent position with a 45-degree head-up tilt. RESULTS At full cervical dilatation an antral CSA less than 300 mm was measured in 76 and 79% of the parturients in the fasting group and the fluid intake groups respectively (P = 0.633). CONCLUSION The current study reveals that the percentage of pregnant women with an 'empty stomach', defined by an antral CSA less than 300 mm in a semirecumbent position with a 45-degree head-up tilt, was comparable at full cervical dilation among those who remained nil by mouth and those allowed to drink up to 400 ml for 90 min after their randomisation. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02362815.
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Cho EA, Huh J, Lee SH, Ryu KH, Shim JG, Cha YB, Kim MS, Song T. Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study. Anesth Analg 2021; 133:690-697. [PMID: 33591115 DOI: 10.1213/ane.0000000000005411] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group. METHODS Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA <2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg >1.5 mL/kg, and Perlas grade. RESULTS CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group - NPO group) was 0.04 (95% confidence interval [CI], -1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, -20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg > 1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0-1) in NPO group and 0.5 (0-1) in NO-NPO group (P = .871). CONCLUSIONS Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.
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Affiliation(s)
- Eun-Ah Cho
- From the Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea.,Department of Anesthesiology and Pain Medicine
| | - Jin Huh
- From the Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea
| | | | | | | | | | | | - Taejong Song
- Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Abstract
Gastric ultrasound (US) is a growing modality within the point-of-care ultrasound (POCUS) field. It provides the ability to directly measure an individual patient's gastric content and has potential use as both a clinical and a research tool. Here, we review the historical development of current gastric US models and their clinical application within the field of general anesthesia, describe the US findings and technique for using POCUS to assess gastric content, and discuss the current and potential applications of gastric POCUS within the emergency department.
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Howle R, Sultan P, Shah R, Sceales P, Van de Putte P, Bampoe S. Gastric point-of-care ultrasound (PoCUS) during pregnancy and the postpartum period: a systematic review. Int J Obstet Anesth 2020; 44:24-32. [PMID: 32693329 DOI: 10.1016/j.ijoa.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022]
Abstract
Personalised risk assessment of the likelihood of pulmonary aspiration is recommended for pregnant women undergoing general anaesthesia and gastric point-of-care ultrasound (PoCUS) may help to achieve this. Traditionally, risk assessment is based upon adherence to fasting times, but gastric emptying may vary during pregnancy and surgery often needs to be expedited. We systematically reviewed the evidence for gastric PoCUS up to August 2018 in pregnant and postpartum women to determine whether it can identify and quantify stomach contents, provide aspiration risk assessment via qualitative or quantitative means, and determine how gastric emptying is affected by pregnancy. Twenty-two articles comprising 1050 participants were included and studies were classified by qualitative or quantitative findings. The evidence suggests that gastric PoCUS is a reliable and feasible method of imaging the stomach in pregnancy in clinical practice. Qualitative assessment via the Perlas grading system can provide rapid assessment of gastric volume states. If fluid is visible, identification of patients at high risk of pulmonary aspiration requires measurement of antral cross-sectional area. Cut-off values of 608 mm2 and 960 mm2 are recommended in the semi-recumbent and right lateral semi-recumbent positions, respectively. Validated methods to quantify stomach volumes are available, however their usefulness is currently restricted to research. Gastric PoCUS also provides evidence that gastric emptying of ingested food is delayed by term pregnancy, labour and during the early postpartum period. However, the passage of fluids through the stomach appears unaffected throughout the peripartum period.
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Affiliation(s)
- R Howle
- University College Hospital, London, UK
| | - P Sultan
- Stanford University School of Medicine, CA, USA; University College London, London, UK
| | - R Shah
- Royal Free Hospital, London, UK
| | - P Sceales
- University College Hospital, London, UK; University College London, London, UK.
| | | | - S Bampoe
- University College Hospital, London, UK; University College London, London, UK
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Dongare PA, Bhaskar SB, Harsoor SS, Garg R, Kannan S, Goneppanavar U, Ali Z, Gopinath R, Sood J, Mani K, Bhatia P, Rohatgi P, Das R, Ghosh S, Mahankali SS, Singh Bajwa SJ, Gupta S, Pandya ST, Keshavan VH, Joshi M, Malhotra N. Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian J Anaesth 2020; 64:556-584. [PMID: 32792733 PMCID: PMC7413358 DOI: 10.4103/ija.ija_735_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Pradeep A Dongare
- Assistant Professor, Department of Anaesthesiology, ESIPGIMSR, Bengaluru, India
| | - S Bala Bhaskar
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari, India
| | - S S Harsoor
- Professor, Department of Anaesthesiology, Dr BR Ambedkar Medical College and Hospital, Bengaluru, India
| | - Rakesh Garg
- Additional Professor, Department of Onco-Anaesthesia, Pain and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Sudheesh Kannan
- Professor, Department of Anaesthesiology, BMCRI, Bengaluru, India
| | - Umesh Goneppanavar
- Professor, Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, India
| | - Zulfiqar Ali
- Associate Professor, Department of Anesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ramachandran Gopinath
- Professor and Head,Department of Anaesthesiology and Intensive Care, ESIC Medical College and Hospital, Hyderabad, India
| | - Jayashree Sood
- Honorary. Joint Secretary, Board of Management, Chairperson, Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Kalaivani Mani
- Scientist IV, Department of Biostatistics, AIIMS, New Delhi, India
| | - Pradeep Bhatia
- Professor and Head, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Rekha Das
- Professor and Head, Department Anaesthesiology, Critical care and Pain, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, India
| | - Santu Ghosh
- Assistant Professor, Department of Biostatistics, St John's Medical College, Bengaluru, India
| | | | - Sukhminder Jit Singh Bajwa
- Professor and Head, Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Punjab, India
| | - Sunanda Gupta
- Professor and Head, Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, India
| | - Sunil T Pandya
- Chief of Anaesthesia and Surgical ICU, AIG Hospitals, Hyderabad, India
| | - Venkatesh H Keshavan
- Senior Consultant and Chief, Department of Neuroanaesthesia and Critical Care, Apollo Hospitals, Bengaluru, India
| | - Muralidhar Joshi
- Head, Department of Anaesthesia and Pain Medicine, Virinchi Hospitals, Hyderabad, India
| | - Naveen Malhotra
- Professor, Department of Anaesthesiology and In Charge Pain Management Centre, Pt BDS PGIMS, Haryana, India
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High-flow nasal oxygen does not increase the volume of gastric secretions during spontaneous ventilation. Br J Anaesth 2020; 125:e75-e80. [DOI: 10.1016/j.bja.2020.02.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/29/2020] [Accepted: 02/27/2020] [Indexed: 12/22/2022] Open
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Point-of-care ultrasound in pregnancy: gastric, airway, neuraxial, cardiorespiratory. Curr Opin Anaesthesiol 2020; 33:277-283. [DOI: 10.1097/aco.0000000000000846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ultrasound assessment of gastric content in fasted patients before elective laparoscopic cholecystectomy: a prospective observational single-cohort study. Can J Anaesth 2020; 67:810-816. [DOI: 10.1007/s12630-020-01668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
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Metodiev Y, Mushambi M. Supraglottic airway devices for Caesarean delivery under general anaesthesia: for all, for none, or for some? Br J Anaesth 2020; 125:e7-e11. [PMID: 32197776 DOI: 10.1016/j.bja.2020.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Yavor Metodiev
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK.
| | - Mary Mushambi
- Department of Anaesthesia, University Hospitals of Leicester, Leicester, UK
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Zhang G, Huang X, Shui Y, Luo C, Zhang L. Ultrasound to guide the individual medical decision by evaluating the gastric contents and risk of aspiration: A literature review. Asian J Surg 2020; 43:1142-1148. [PMID: 32171605 DOI: 10.1016/j.asjsur.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/16/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022] Open
Abstract
Pulmonary aspiration of gastric contents is one of the most terrible complications following general anesthesia. It is important for patients to prevent this complication by obeying the preoperative fasting protocol strictly. At present, it has been reported by many studies that bedside ultrasound, as a non-invasive and convenient method, could be used to evaluate gastric contents qualitatively and quantitatively. With the advantages of reliability, accuracy and repeatability, it can greatly reduce the risk of aspiration and ensure patients' life security. But most of the data were acquired from the healthy volunteers. For the gastrointestinal disorder, the pregnant women, obesity, children, the elderly and diabetes patients, the accuracy and reliability of ultrasound to predict the risk of aspiration remains to be identified by more further studies. For these patients with increasing risk of aspiration, I-AIM (Indication, Acquisition, Interpretation, Medical decision-making) framework plays an important role in ensuring the safety of patients. It is crucial to make appropriate clinical decisions by evaluating the gastric contents with ultrasound.
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Affiliation(s)
- Gang Zhang
- Department of Anesthesia, Sichuan Provincial Orthopedic Hospital (Chengdu Sports Hospital and Chengdu Research Institute for Sports Injury), Chengdu, 610041, China
| | - Xiaoyan Huang
- Operation Room, The Third People's Hospital of Chengdu, Chengdu, 610031, China
| | - Yunhua Shui
- Department of Anesthesia, Sichuan Provincial Orthopedic Hospital (Chengdu Sports Hospital and Chengdu Research Institute for Sports Injury), Chengdu, 610041, China
| | - Chunqiong Luo
- Department of Anesthesia, Sichuan Provincial Orthopedic Hospital (Chengdu Sports Hospital and Chengdu Research Institute for Sports Injury), Chengdu, 610041, China
| | - Lan Zhang
- Department of Anesthesia, Sichuan Provincial Orthopedic Hospital (Chengdu Sports Hospital and Chengdu Research Institute for Sports Injury), Chengdu, 610041, China.
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Popivanov P, Irwin R, Walsh M, Leonard M, Tan T. Gastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: an observational study. Int J Obstet Anesth 2020; 41:29-34. [DOI: 10.1016/j.ijoa.2019.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/26/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
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Temel ME, Totoz T, Erkalp K, Temel GS, Selcan A. A randomized, double-blind study of the ultrasound assessment of the effect of pharyngeal packing on perioperative gastric volume in nasal surgery. BMC Anesthesiol 2019; 19:121. [PMID: 31286899 PMCID: PMC6615168 DOI: 10.1186/s12871-019-0786-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Pharyngeal packing (PP) is commonly performed to reduce the incidence of perioperative blood ingestion (PBI) in nasal surgery (NS), and thus the incidence and severity of postoperative nausea and vomiting (PONV). This study examined the effects of PP on the perioperative gastric volume (GV) and PONV in patients undergoing NS, by ultrasound assessment. Methods Patients undergoing elective NS [septoplasty, septo-rhinoplasty (SRP) and functional endoscopic sinus surgery (FESS)] were randomised to receive or not receive PP. In the PP group, pharyngeal packs were placed after the orotracheal intubation. Ultrasound assessments were performed for all patients preoperatively (before the anaesthesia induction) and postoperatively (before the extubation). The antero-posterior (AP) and cranio-caudal (CC) antral diameters, antral cross-sectional area (ACSA), and total GV were calculated. PONV incidence and severity were rated. These variables were compared between timepoints and groups, and in the subgroup analyses according to the surgery type. Pearson correlation analysis was performed to assess correlations between the variables. Results AP and CC diameters and ACSAs were greater postoperatively than preoperatively in the PP and non-PP groups (n = 44 each; all p < 0.05). Postoperative AP and CC diameters and the ACSA were greater in the non-PP than in the PP group (all p < 0.05). Postoperative AP diameters were greater than preoperatively in patients undergoing SRP and FESS, and the postoperative CC diameter and ACSA were greater than preoperatively in patients undergoing SRP (all p < 0.05). Surgery duration was correlated positively with postoperative AP diameter (r = 0.380, p < 0.05), CC diameter (r = 0.291, p < 0.05), and ACSA (r = 0.369, p < 0.05). Patients who underwent septoplasty surgery, PP was decreased PONV incidence and severity at the first four hours, postoperatively (p < 0.05). Conclusions The study findings indicate that PP reduces the increase in the perioperative GV due to PBI in an elective NS. It is therefore a useful and safe means of reducing the risk of perioperative pulmonary aspiration in such surgeries. Trial registration Australian New Zealand Clinical Trials Registry (ANZCT), ACTRN12619000487112, 25/03/2019, Trial registration retrospectively registered.
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Affiliation(s)
| | - Tolga Totoz
- Nisantasi University, Istanbul Safak Hospital, Istanbul, Turkey
| | - Kerem Erkalp
- Health Sciences University, Istanbul Bagcılar Training and Educational Hospital, Istanbul, Turkey.
| | | | - Aysin Selcan
- Health Sciences University, Istanbul Bagcılar Training and Educational Hospital, Istanbul, Turkey
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Novitch M, Prabhakar A, Siddaiah H, Sudbury AJ, Kaye RJ, Wilson KE, Haroldson A, Fiza B, Armstead-Williams CM, Cornett EM, Urman RD, Kaye AD. Point of care ultrasound for the clinical anesthesiologist. Best Pract Res Clin Anaesthesiol 2019; 33:433-446. [PMID: 31791562 DOI: 10.1016/j.bpa.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023]
Abstract
Diagnostic ultrasonography was first utilized in the 1940s. The past 70+ years have seen an explosion in both ultrasound technology and availability of ultrasound technology to more and more clinicians. As ultrasound technology and availability have grown, the utility of ultrasound technology in the clinical setting as only been limited by clinicians' imagination. Due to its lack of radiation, non-invasive nature, and gentle learning curve, medical ultrasonography is now a tremendously useful Point of Care technology in the clinical arena. What follows is a discussion of Point of Care Ultrasound (PoCUS) and how it can be incorporated in the daily practice of any regional anesthesiology. While most regional anesthesiologists usually focus on the interventional aspects of ultrasonography (i.e. nerve blocks), our discussion will center on the diagnostic value of ultrasonography-especially concerning assessment of cardiac physiology and pathophysiology, gastric anatomy, airway anatomy, and intracranial pathophysiology. After reading and reviewing this chapter, the learner will have the knowledge to start training themselves in a variety of PoCUS exams that will allow rapid diagnosis of normal and abnormal patient conditions. Once an accurate diagnosis is established, the anesthesiologist and his/her team can then confidently optimize an anesthetic pain, prevent harm, and/or treat a patient condition. In this day and age, the ability to rapidly establish an accurate diagnosis cannot be overstated-especially in a critical situation. It is the authors' sincerest hope that the following discussion will help regional anesthesiologist to become even better and well-rounded clinical leaders.
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Affiliation(s)
- Matthew Novitch
- Department of Anesthesiology, University of Washington, 520 Terry Ave, Seattle, WA 98104, USA.
| | - Amit Prabhakar
- Department of Anesthesiology, Emory University School of Medicine, 550 Peachtree St NE, Atlanta, GA 30308, USA.
| | - Harish Siddaiah
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Anna J Sudbury
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226, USA.
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Kyle E Wilson
- M3, LSUHSC New Orleans School of Medicine, 1901 Period St., New Orleans, LA 70112, USA.
| | - Alexander Haroldson
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226, USA.
| | - Babar Fiza
- Department of Anesthesiology, Division of Critical Care, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA.
| | - C M Armstead-Williams
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA 70112, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
| | - Alan D Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA 70112, USA.
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Amaral CK, Benevides ML, Benevides MM, Sampaio DL, Fontes CJF. Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31006483 PMCID: PMC9391917 DOI: 10.1016/j.bjane.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and objectives Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. Method In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. Results The median (IIQ) for gastric antral cross-sectional area was 4 cm2 (2.8–6.3), for the estimated gastric volume it was 49.8 mL (33.7–87.2), and for the gastric volume estimated in mL.kg−1 it was 0.62 mL.kg−1 (0.39–0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3 cm2 (95% CI: 7.6–15.6) and 1.42 mL.kg−1 (95% CI: 1.20–2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2–9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p < 0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p < 0.01 and p < 0.02. Conclusion Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.
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Amaral CK, Benevides ML, Benevides MM, Sampaio DL, Fontes CJF. [Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section]. Rev Bras Anestesiol 2019; 69:266-271. [PMID: 31006483 DOI: 10.1016/j.bjan.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 01/14/2019] [Accepted: 03/03/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. METHOD In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥ 30. RESULTS The median (IIQ) for gastric antral cross-sectional area was 4cm2 (2.8-6.3), for the estimated gastric volume it was 49.8mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤ 10.3cm2 (95% CI: 7.6-15.6) and 1.42mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8). There was a positive correlation between gastric antral cross-sectional area and weight, p <0.001 and body mass index <0.001. Patients with a body mass index ≥ 30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p <0.01 and p <0.02. CONCLUSION Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.
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Bouvet L, Barnoud S, Desgranges F, Chassard D. Effect of body position on qualitative and quantitative ultrasound assessment of gastric fluid contents. Anaesthesia 2019; 74:862-867. [DOI: 10.1111/anae.14664] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Affiliation(s)
- L. Bouvet
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
- Department of Anaesthesia University of Lyon Université Claude Bernard Lyon 1 Centre Léon Bérard INSERM LabTAU UMR1032 Lyon France
| | - S. Barnoud
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
| | - F.‐P. Desgranges
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
| | - D. Chassard
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
- Department of Anaesthesia University of Lyon Université Claude Bernard Lyon 1 Villeurbanne France
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Gal O, Rotshtein M, Feldman D, Mari A, Hallak M, Kopelman Y. Estimation of Gastric Volume Before Anesthesia in Term-Pregnant Women Undergoing Elective Cesarean Section, Compared With Non-pregnant or First-Trimester Women Undergoing Minor Gynecological Surgical Procedures. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2019; 12:1179562X19828372. [PMID: 30899153 PMCID: PMC6419245 DOI: 10.1177/1179562x19828372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditionally, intubation of pregnant women has been performed using a rapid sequence induction. This is due to the classical concept that women with more than 18 weeks of pregnancy (mid-second trimester) are always considered to have an increased risk of aspiration due to a number of factors, regardless of the fasting duration. Rapid sequence induction is associated with a higher rate of adverse events. AIMS Our study aimed to illuminate the hypothesis that there is no difference in gastric volume between term-pregnant women and non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Accordingly, we measured gastric volume and content before anesthesia in term-pregnant women undergoing elective cesarean section, and to compare it with non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. METHODS In this single-center prospective study, the gastric volume and content were assessed by abdominal ultrasound (AUS) just prior to the scheduled procedure. AUS was performed in the sagittal or para-sagittal plain in the upright position and the stomach content was estimated according to the antral circumferential area. Group 1 consisted of 50 term-pregnant women scheduled for cesarean section. Group 2 consisted of 45 non-pregnant or first-trimester pregnant women who were scheduled for minor gynecologic procedure. RESULTS Despite significant longer fasting time prior to the interventional procedure in the non-pregnant or first-trimester women group, there was no significant difference in gastric volume between term-pregnant and first-trimester pregnant women (3.2 ± 0.97 cm2 vs 3.2 ± 0.79 cm2; P = .97). Gastric volume was small in the two groups. CONCLUSION Fasting gastric volume before cesarean section in term-pregnant women is small and is not different than in non-pregnant or first-trimester women undergoing minor gynecologic procedures. Ultrasound estimation of gastric volume is a reliable and easy-to-perform technique which might help in decision-making regarding the airway management prior to induction of anesthesia in pregnant women.
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Affiliation(s)
- Oren Gal
- Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Mark Rotshtein
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Obstetric Anesthesia Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Dan Feldman
- Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Amir Mari
- Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Motti Hallak
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Obstetric and Gynecology Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yael Kopelman
- Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Desgranges FP, Simonin M, Barnoud S, Zieleskiewicz L, Cercueil E, Erbacher J, Allaouchiche B, Chassard D, Bouvet L. Prevalence and prediction of higher estimated gastric content in parturients at full cervical dilatation: A prospective cohort study. Acta Anaesthesiol Scand 2019; 63:27-33. [PMID: 30084204 DOI: 10.1111/aas.13220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/06/2018] [Accepted: 07/13/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Emergent obstetrical procedures may require general anaesthesia in parturients at full cervical dilatation or immediately after vaginal birth. This study aimed to determine the prevalence and the predictive factors of higher estimated gastric content in parturients at full cervical dilatation with epidural analgesia and allowed to drink during the labour, and to assess the ability of the antral area measured in the semirecumbent position (SR-CSA) to identify higher estimated gastric content in this setting. METHODS This prospective observational study was conducted between December 2016 and July 2017. Ultrasonographic examination of the antrum was performed at full cervical dilatation, within the hour preceding the beginning of expulsive efforts. Higher estimated gastric content was defined when solid content was observed and/or if the calculated gastric fluid volume was >1.5 mL/kg. RESULTS Seventeen of 62 parturients (27%) presented higher estimated gastric content. Maximal pain intensity during the last hour of labour and time interval between the insertion of the epidural catheter and ultrasonographic examination were significantly increased in parturients with higher estimated gastric content. The threshold value of the SR-CSA to identify a higher estimated gastric content was 393 mm2 , with sensitivity = 88% and specificity = 87%. CONCLUSION Around a quarter of parturients with epidural analgesia and free access to clear fluids during labour presented higher estimated gastric content at full cervical dilatation. The SR-CSA may be of interest for the fast ultrasound assessment of the gastric content status in case of emergent obstetrical procedures at full cervical dilatation.
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Affiliation(s)
- François-Pierrick Desgranges
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
- Research Unit APCSe VetAgro Sup UPSP 2016.A101; Claude Bernard Lyon 1 University; Marcy-l'Etoile France
| | - Marine Simonin
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
| | - Sophie Barnoud
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
| | - Laurent Zieleskiewicz
- Department of Anesthesia and Intensive Care; University Hospital of Marseille; Marseille France
| | - Eloise Cercueil
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
| | - Julien Erbacher
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
| | - Bernard Allaouchiche
- Research Unit APCSe VetAgro Sup UPSP 2016.A101; Claude Bernard Lyon 1 University; Marcy-l'Etoile France
- Department of Anesthesia and Intensive Care; Lyon Sud Hospital; Hospices Civils de Lyon; Pierre-Bénite France
| | - Dominique Chassard
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
- Research Unit APCSe VetAgro Sup UPSP 2016.A101; Claude Bernard Lyon 1 University; Marcy-l'Etoile France
| | - Lionel Bouvet
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
- Research Unit APCSe VetAgro Sup UPSP 2016.A101; Claude Bernard Lyon 1 University; Marcy-l'Etoile France
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Martínez-Rodríguez JE, Camacho-Yacumal A, Unigarro-Benavides LV, Nazareno DY, Fernández-Pabón J, Burbano-Imbachí A, Cardona-Gómez DC, Cedeño-Burbano AA. Anestesia para pacientes con preeclampsia. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n1.65756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La preeclampsia es una enfermedad con alta frecuencia a nivel mundial relacionada con la gestación. Las pacientes que la padecen pueden precisar un procedimiento anestésico por diversos motivos, incluidas las complicaciones graves.Objetivo. Realizar una revisión narrativa de la literatura respecto a las pautas principales del tratamiento anestésico de pacientes con preeclampsia.Materiales y métodos. Se realizó una búsqueda estructurada en las bases de datos ProQuest, EBSCO, ScienceDirect, PubMed, LILACS, Embase, Trip Database, SciELO y Cochrane Library con los términos Anesthesia AND pre-eclampsia AND therapeutics; hypertension, Pregnancy-Induced AND anesthesia AND therapeutics; anesthesia AND pre-eclampsia; hypertension, pregnancy induced AND anesthesia. La búsqueda se hizo en inglés con sus equivalentes en español.Resultados. Se encontraron 61 artículos con información relevante para el desarrollo de la presente revisión.Conclusiones. Una valoración preanestésica y la instauración temprana de las técnicas analgésicas y anestésicas pueden mitigar el impacto de complicaciones derivadas del curso de la preeclampsia. Respecto a desenlaces mayores, no existe diferencia significativa entre los distintos tipos de anestesia.
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Ohashi Y, Farzi S, Siddiqui N. The use of lumbar spine and gastric ultrasound in perioperative obstetric anesthesia. HYPERTENSION RESEARCH IN PREGNANCY 2018. [DOI: 10.14390/jsshp.hrp2018-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yayoi Ohashi
- Department of Anaesthesia and Pain Medicine, Fiona Stanley Fremantle Hospitals Group
| | - Sahar Farzi
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Clinician Scientist, Lunenfeld-Tanenbaum Research Institute
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Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30195629 PMCID: PMC9391824 DOI: 10.1016/j.bjane.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. Methods We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10 h and was subjected to a baseline gastric ultrasound, intake of 400 mL of coconut water or a 145 g, 355 kcal meat sandwich, and sonographic gastric evaluations after 10 min and every hour until the stomach was completely empty. Results At baseline, all subjects had an empty stomach. At 10 min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2 mL for liquid and solid foods, respectively (p > 0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9 h for liquid and solid foods, respectively (p < 0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. Conclusions Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.
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Chen X, Chen F, Zhao Q, Zhang L, Liu Z. Ultrasonographic measurement of antral area for estimating gastric fluid volume in pregnant women. J Clin Anesth 2018; 53:70-73. [PMID: 30343226 DOI: 10.1016/j.jclinane.2018.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To calculate the stomach volume according to the antral area in pregnant women. DESIGN Prospective observational study. SETTING One of the maternity units in our hospital. PATIENTS 24 singleton pregnancy women, over 18-year-old, non-laboring, gestational age ≥ 36 weeks, ASA physical status I to II were involved in our study. INTERVENTIONS AND MEASUREMENTS An ultrasound assessment of the antrum was performed to the pregnant women after 8 hours fasting for the first time. Those lacking of visualization of any gastric contents in the antrum in both the supine and the right lateral decubitus positions were included in our study. Thereafter 50 ml of water was ingested, 4 times, 200 ml in total. The antrum area was examined 2mins after each 50 ml ingest of water. MAIN RESULTS A high correlation between CSA and volume of liquid ingested (r = 0.90,P < 0.01) was found. We can construct a formula for the prediction of volume values based on the measured CSA values and demographic variables. The equation is: Volumeml=270.76+13.68∗CSA-1.20∗gestationalage CONCLUSIONS: Bedside antrum area examination by ultrasonography can provide quantitative information for the assessment of the gastric content and volume in the pregnant women. We can calculate the actual stomach capacity according to the CSA of the gastric antrum.
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Affiliation(s)
- Xiubin Chen
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Fenghua Chen
- Department of ultrasonography, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Qingsong Zhao
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Lina Zhang
- Department of Biostatistics, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China.
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Carmona BM, Almeida CCA, Vieira WDB, Fascio MDNC, Carvalho LRD, Vane LA, Barbosa FT, do Nascimento Junior P, Módolo NSP. [Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers]. Rev Bras Anestesiol 2018; 68:584-590. [PMID: 30195629 DOI: 10.1016/j.bjan.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. METHODS We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10h and was subjected to a baseline gastric ultrasound, intake of 400mL of coconut water or a 145g, 355kcal meat sandwich, and sonographic gastric evaluations after 10min and every hour until the stomach was completely empty. RESULTS At baseline, all subjects had an empty stomach. At 10min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2mL for liquid and solid foods, respectively (p>0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9h for liquid and solid foods, respectively (p<0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. CONCLUSIONS Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.
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Affiliation(s)
| | | | - Waldônio de Brito Vieira
- Fundação Santa Casa de Misericórdia do Pará, Departamento de Radiologia e Imagem de Diagnóstico, Belém, PA, Brasil
| | | | | | - Luiz Antonio Vane
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatu, SP, Brasil
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Term pregnant patients have similar gastric volume to non-pregnant females: a single-centre cohort study. Br J Anaesth 2018; 122:79-85. [PMID: 30579409 DOI: 10.1016/j.bja.2018.07.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The physiological changes of pregnancy can increase the risk of peri-partum pulmonary aspiration. There is limited objective information regarding gastric volumes in pregnant patients. The aim of this cohort study was to characterise prospectively the range of gastric-fluid volume in term non-labouring pregnant patients compared with a historical cohort of non-pregnant females. METHODS Fasted non-labouring term pregnant patients scheduled for elective Caesarean delivery underwent a standardised gastric ultrasound examination. Gastric content was evaluated qualitatively (type of content), semi-quantitatively (Perlas grades), and quantitatively (volume). The antral cross-sectional area and volume were compared with those of a retrospective cohort of non-pregnant females from the same institution. Descriptive statistics were used to describe the central tendency through mean and median values. Dispersion was evaluated with standard deviation and inter-quartile range, and the higher end of the distribution as 95th percentile. RESULTS Non-labouring pregnant (59) and non-pregnant (81) subjects were studied. The range of estimated total gastric-fluid volume (P=0.96) and volume per body weight (P=0.78) was not significantly different between cohorts. An estimated volume of 115 ml (102-143) vs 136 ml (106-149) and volume per body weight of 1.4 ml kg-1 (1.2-2.8) vs 2.0 ml kg-1 (1.5-2.7) corresponded to the 95th percentile (95% confidence interval) values in the pregnant and non-pregnant cohort, respectively. CONCLUSIONS Baseline gastric volume of non-labouring pregnant patients at term is not significantly different from that of non-pregnant females. This information will be helpful to interpreting findings of gastric point-of-care ultrasound in obstetric patients.
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Affiliation(s)
- S. M. Kinsella
- Department of Anaesthesia St Michael's Hospital Bristol UK
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Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M. Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management. Anaesthesia 2018; 73:1265-1279. [DOI: 10.1111/anae.14354] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Aix Marseille university C2VN France
| | - L. Bouvet
- Department of Anaesthesia and Intensive Care Medicine Hospices Civils de Lyon Hôpital Femme Mère Enfant Bron France
| | - S. Einav
- General Intensive Care Shaare Zedek Medical Centre Hebrew University Faculty of Medicine Jerusalem Israel
| | - G. Duclos
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
| | - M. Leone
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
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„Rapid sequence induction and intubation“ beim aspirationsgefährdeten Patienten. Anaesthesist 2018; 67:568-583. [DOI: 10.1007/s00101-018-0460-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 12/19/2022]
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Ultrasound examination of the antrum to predict gastric content volume in the third trimester of pregnancy as assessed by MRI. Eur J Anaesthesiol 2018; 35:379-389. [DOI: 10.1097/eja.0000000000000749] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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