European Journal of Anaesthesiology Intensive Care· 2023Q2· Review
The role of gastric ultrasound in anaesthesia for emergency surgery
- 9citations
- Q2SCImago
- 2023year
Short summary
Gastric ultrasound accurately assesses residual stomach contents in emergency surgery patients, revealing a high incidence (18-56%) of a 'full stomach' irrespective of fasting time, thus improving anesthesia decision-making.
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Key points
- 18-56% of emergency surgery patients have residual gastric contents at induction.
- Preoperative fasting time does not reliably predict gastric content.
- Risk factors for a full stomach include abdominal/gynecological surgery, high BMI, and morphine use.
- Gastric ultrasound is a cost-efficient bedside tool for assessing gastric contents.
AI-generated from the title and abstract; the full text is not read.
Abstract
BACKGROUND: The timing and technique of anaesthesia are challenging in patients with a history of recent food intake. The presence of gastric contents increases the risk of aspiration, potentially resulting in acute lung injury, pneumonia, or death. Delayed gastric emptying complicates the estimation of aspiration risk. Surprisingly, there are no fasting guidelines for emergency surgery. Point-of-care gastric ultrasound is a time-efficient, cost-efficient and accurate bedside tool with which to estimate residual gastric content and to guide decision-making in airway management and timing of general anaesthesia. This review summarises the prevailing concepts of ultrasound-guided gastric content assessment for emergency surgery. METHODS: Medline and Embase databases were searched for studies using ultrasound for the evaluation of gastric content in adults scheduled for emergency surgery. RESULTS: Five prospective observational studies representing 793 emergency surgery patients showed that the incidence of 'full stomach' was between 18 and 56% at the time of induction. Risk factors for a full stomach before emergency surgery were abdominal or gynaecological/obstetric surgery, high body mass index and morphine consumption. No correlation between preoperative fasting time and the presence of a full/empty stomach was found. No deaths due to aspiration were reported. CONCLUSION: The preoperative presence of gastric content before emergency surgery is high and the estimates used for clinical management are unreliable. This review demonstrates that gastric ultrasound is a valuable tool for evaluating gastric content. A flow chart for medical decision-making using gastric ultrasound before emergency surgery was developed to assist in clinical decision-making. The validity and practical applicability should be assessed in future studies.
The authors' abstract, as published at the source. European Journal of Anaesthesiology Intensive Care, 2023 · DOI ↗
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Field: Surgery
SurgeryMedicine