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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Van de Putte P, Herijgers A, Wallyn A, Bleeser T, Van Dijck L, Calle B, Del Jesus Sanchez Fernandez J, Dogrul F, Hendrickx E. The correlation between patient satiety sensation and total gastric fluid volume: a prospective observational study. Can J Anaesth 2023; 70:1307-1314. [PMID: 37353726 DOI: 10.1007/s12630-023-02508-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 06/25/2023] Open
Abstract
PURPOSE Surgical patients are asked to adhere to preoperative fasting guidelines to minimize gastric contents. Large fluid volumes or solid content can still be present as shown with gastric ultrasound. It has been suggested that additional rating of patients' satiety, measured as the feeling of hunger and thirst, could help clinicians to better judge emptying of the stomach. METHODS We performed a prospective observational study in fasted elective surgical patients. The primary objective was to investigate the correlation between hunger measured on a 0-10 numeric rating scale and total gastric fluid volume measured with gastric ultrasonography. Secondary objectives included the correlation between 1) thirst and total gastric fluid volume and 2) hunger, thirst, and the Perlas grading scale score. RESULTS We included 515 patients. The exam was inconclusive in 14 individuals (2.7%). The Spearman correlation coefficient between gastric fluid volumes and hunger was 0.11 (95% confidence interval [CI], 0.02 to 0.20) (P = 0.01). The correlation between gastric fluid volumes and thirst was 0.11 (95% CI, 0.02 to 0.20) (P = 0.02). Between antral grades and numeric rating scale, the correlation coefficient was 0.00 (95% CI, -0.09 to 0.09) (P = 1.00) for thirst and 0.00 (95% CI, -0.08 to 0.09) (P = 0.94) for hunger. Ten patients (2.0%) had solid content, 24 presented a grade 2 antrum (4.8%). CONCLUSION This study suggests that the correlation between total gastric fluid volume and satiety sensation is very weak. Satiety did not reliably predict total gastric fluid volume. STUDY REGISTRATION ClinicalTrials.gov (NCT04884373); registered 13 May 2021.
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Affiliation(s)
- Peter Van de Putte
- Department of Anesthesiology, Imeldaziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium.
| | - Anneleen Herijgers
- Department of Anesthesiology, Universitaire Ziekenhuizen Leuven, Herestraat, Belgium
| | - An Wallyn
- Department of Anesthesiology, Imeldaziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Tom Bleeser
- Department of Anesthesiology, Universitaire Ziekenhuizen Leuven, Herestraat, Belgium
| | - Lisa Van Dijck
- Department of Anesthesiology, Universitaire Ziekenhuizen Leuven, Herestraat, Belgium
| | - Brecht Calle
- Department of Anesthesiology, Imeldaziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | | | - Fikriye Dogrul
- Department of Anesthesiology, Universitaire Ziekenhuizen Leuven, Herestraat, Belgium
| | - Ellen Hendrickx
- Department of Anesthesiology, Imeldaziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
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Van de Putte P, Jahr JS, Gieraerts R, Hanam-Jahr J, Van de Velde M. Pruritus, neuraxial morphine and recrudescence of oral herpes simplex and treatment: an educational review in obstetric patients. Reg Anesth Pain Med 2022; 47:rapm-2021-103461. [PMID: 35534019 DOI: 10.1136/rapm-2021-103461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/19/2022] [Indexed: 11/04/2022]
Abstract
Neuraxial opioids are well known to cause itching, which may be challenging to treat. Neuraxial morphine has been demonstrated to cause recrudescent herpes simplex viruses (HSV-1), especially in women during labor and childbirth with neuraxial analgesia, and may be an occult etiology of refractory itching. This educational review summaries the clinical and epidemiological characteristics associated with recrudescent HSV-1 in patients treated with neuraxial opioids, especially morphine.
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Affiliation(s)
| | - Jonathan S Jahr
- Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Jamielynn Hanam-Jahr
- Anesthesiology, Beverly Hills Aesthestic Dentistry, Beverly Hills, California, USA
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Vernieuwe L, Wallyn A, Van Dyck L, Van de Putte P. Gastric ultrasound for feeding intolerance in the ICU: close but not quite right. BMC Gastroenterol 2022; 22:33. [PMID: 35078409 PMCID: PMC8787883 DOI: 10.1186/s12876-022-02104-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 01/12/2022] [Indexed: 01/15/2023] Open
Abstract
In the January 2021 issue of BMC Gastroenterology, Elmokadem et al. report their findings on the use of gastric ultrasound (GUS) for the evaluation of feeding intolerance—defined as high gastric residual volume—in critically ill patients. We voice in this correspondence our concerns regarding certain methodological flaws and believe the study results should be interpreted with caution. The authors applied a model unvalidated for non-clear fluids as enteral feeding, the scanning protocol was not clearly described and essential anatomical landmarks required for correct interpretation are not visible in the presented images. Additionally, since GUS was not compared to a gold standard, we believe the authors’ conclusion may be overoptimistic and does not undoubtedly answer the primary outcome.
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Moon TS, Van de Putte P, De Baerdmaeker L, Schumann R. In Response. Anesth Analg 2021; 132:e117. [PMID: 34032682 DOI: 10.1213/ane.0000000000005516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Tiffany S Moon
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Luc De Baerdmaeker
- Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Roman Schumann
- Departments of Anesthesiology and Surgery, Tufts University School of Medicine, Boston, Massachusetts
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Van de Putte P, Delplanque L, Hulens M, De Mulder P. “Cervicalgia: Check Your First Rib”. Pain Medicine 2021. [DOI: 10.1093/pm/pnab095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Loic Delplanque
- Department of Anesthesia, Imeldaziekenhuis, Bonheiden, Belgium
| | - Mieke Hulens
- Musculoskeletal Rehabilitation Research Unit, Faculty of Kinesiology and Rehabilitation, UZ Leuven, Leuven, Belgium
| | - Peter De Mulder
- Department of Anesthesia, Imeldaziekenhuis, Bonheiden, Belgium
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Abstract
The prevalence of obesity continues to rise worldwide, and anesthesiologists must be aware of current best practices in the perioperative management of the patient with obesity. Obesity alters anatomy and physiology, which complicates the evaluation and management of obese patients in the perioperative setting. Gastric point-of-care ultrasound (PoCUS) is a noninvasive tool that can be used to assess aspiration risk in the obese patient by evaluating the quantity and quality of gastric contents. An important perioperative goal is adequate end-organ perfusion. Standard noninvasive blood pressure (NIBP) is our best available routine surrogate measurement, but is vulnerable to greater inaccuracy in patients with obesity compared to the nonobese population. Current NIBP methodologies are discussed. Obese patients are at risk for wound and surgical site infections, but few studies conclusively guide the exact dosing of intraoperative prophylactic antibiotics for them. We review evidence for low-molecular-weight heparins and weight-based versus nonweight-based administration of vasoactive medications. Finally, intubation and extubation of the patient with obesity can be complicated, and evidence-based strategies are discussed to mitigate danger during intubation and extubation.
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Affiliation(s)
- Tiffany S Moon
- From the Department of Anesthesiology and Pain, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Roman Schumann
- Department of Anesthesiology and Perioperative Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Van de Putte P, Blockmans D, De Rop C, Versyck B. Pectoral Nerve Block Type II as the Sole Anesthetic for Removal of a Large Axillary Tumor: A Case Report. A A Pract 2020; 14:e01201. [DOI: 10.1213/xaa.0000000000001201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sebrechts T, Perlas A, Abbas S, Van de Putte P. Serial Gastric Ultrasound to Evaluate Gastric Emptying After Prokinetic Therapy With Domperidone and Erythromycin in a Surgical Patient With a Full Stomach: A Case Report. A A Pract 2018; 11:106-108. [PMID: 29634526 DOI: 10.1213/xaa.0000000000000755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fasting guidelines are used to prevent perioperative aspiration but they are only reliable in healthy elective patients. Point-of-care gastric ultrasound allows qualitative and quantitative evaluation of gastric contents at the bedside. This case report describes the use of serial gastric point-of-care ultrasound to evaluate the effect of prokinetic therapy with domperidone and erythromycin in an elective surgical patient with multiple comorbidities who presented with a full stomach.
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Affiliation(s)
- Tom Sebrechts
- From the Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium
| | - Anahi Perlas
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sheriff Abbas
- Department of Anaesthesiology, University Hospital Leuven, Leuven, Belgium
| | - Peter Van de Putte
- Department of Anesthesiology, AZ Monica, campus Deurne, Deurne, Belgium.,Department of Anesthesiology, UMC Radboud, Nijmegen, the Netherlands
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Perlas A, Arzola C, Van de Putte P. Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review. Can J Anaesth 2017; 65:437-448. [DOI: 10.1007/s12630-017-1031-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022] Open
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Vernieuwe L, Van de Putte P. Ultrasound-guided supraclavicular block in a patient with no first rib. J Clin Anesth 2015; 27:361-2. [PMID: 25762505 DOI: 10.1016/j.jclinane.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Lynn Vernieuwe
- Department of Anesthesiology, University Hospital Antwerp, Edegem, Belgium
| | - Peter Van de Putte
- Department of Anesthesiology, AZ Monica, Campus Deurne, Deurne, Belgium.
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Van de Putte P. Bedside gastric ultrasonography to guide anesthetic management in a nonfasted emergency patient. J Clin Anesth 2013; 25:165-6. [DOI: 10.1016/j.jclinane.2012.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 10/05/2012] [Accepted: 10/05/2012] [Indexed: 11/29/2022]
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