ABSTRACT
Abstract Background Pulmonary aspiration is one of the most important complications in anesthesiology. Assessment of gastric content by ultrasound is a good method to quantify gastric volume and to determine the risk of intraoperative pulmonary aspiration. The aim of this study is to determine the accuracy of the gastric ultrasonography in the qualitative analysis of gastric content, mainly in the analysis of small amounts of liquid content. Methods Gastric ultrasound was performed to 36 patients before upper gastrointestinal endoscopy (UGI), making two longitudinal scans at the epigastric level, one in supine position and the other in right lateral decubitus position, measuring two diameters and the area of the gastric antrum and assessing the content characteristics determining whether it was an empty stomach or contained fluid or solid content. Subsequently, the ultrasound findings were compared with UGI findings. Results Gastric areas were analyzed by the trace and the lengths of the craniocaudal and anteroposterior axes concluding that there are no significant differences between the two methods. No statistically significant difference was found between UGI and US assessment technics. No statistically significant difference was found between the estimated volume by UGI and US. Conclusions Though our study has some limitations, qualitative analysis of gastric content using ultrasound followed by endoscopy enabled the conclusion that there are no differences in the qualitative assessment regarding these two techniques, supporting the important role of point-of-care gastric ultrasound (POCGUS) in the assessment of pulmonary aspiration risk by the anesthesiologist in the perioperative period.
Subject(s)
Humans , Stomach/diagnostic imaging , Gastrointestinal Contents/diagnostic imaging , Pyloric Antrum/diagnostic imaging , Prospective Studies , Ultrasonography/methodsABSTRACT
OBJECTIVE@#To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients.@*METHODS@#Ninety obese patients (BMI 30-39.9 kg/m@*RESULTS@#The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T (@*CONCLUSIONS@#Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.
Subject(s)
Humans , Anesthesia, General , Insufflation , Intubation, Intratracheal , Masks , ObesityABSTRACT
Abstract Background and objectives: Preoperative fasting may lead to undesirable effects in the surgical patient in whom there is a stimulus to ingesting clear liquids until 2 hours before anesthesia. The aim of this study was to evaluate the gastric emptying of two different solutions using ultrasound. Methods: In a prospective, randomized, blind study, 34 healthy volunteers ingested 200 mL of two solutions without residues in two steps: an isotonic solution with carbohydrates, electrolytes, osmolarity of 292 mOsm.L-1, and 36 kcal; and other nutritional supplementation with carbohydrates, proteins, electrolytes, osmolarity of 680 mO.L-1, and 300 kcal. After 2 hours, a gastric ultrasound was performed to assess the antrum area and gastric volume, and the relation of gastric volume to weight (vol.w-1), whose value above 1.5 mL.kg-1 was considered a risk for bronchoaspiration. A p-value <0.05 was considered statistically significant. Results: There was a significant difference between all parameters evaluated 2 hours after the ingestion of nutritional supplementation compared to fasting. The same occurred when the parameters between isotonic solution and nutritional supplementation were compared 2 hours after ingestion. Only one patient had vol.w-1 <1.5 mL.kg-1 2 hours after ingestion of nutritional supplementation; and only one had vol.w-1 >1.5 mL.kg-1 after ingestion of isotonic solution. Conclusion: This study demonstrated that gastric emptying of equal volumes of different solutions depends on their constitution. Those with high caloric and high osmolarity, and with proteins present, 2 hours after ingestion, increased the gastric volumes, which is compatible with the risk of gastric aspiration.
Resumo Justificativa e objetivos: O jejum pré-operatório pode levar a efeitos indesejáveis no paciente cirúrgico, em que há um estimulo à ingestão de líquidos sem resíduos até 2 horas antes da anestesia. O objetivo deste estudo foi avaliar o esvaziamento gástrico de duas soluções diferentes por meio da ultrassonografia. Métodos: Em um estudo prospectivo, randomizado, cego, 34 voluntários saudáveis ingeriram 200 mL de duas soluções sem resíduos, em duas etapas: uma solução isotônica com carboidratos, eletrólitos, osmolaridade de 292 mOsm.L-1 e 36 kcal; e outra suplementação nutricional, com carboidratos, proteínas, eletrólitos, osmolaridade de 680 mOs.L-1 e 300 kcal. Após 2 horas, fez-se ultrassonografia gástrica com avaliação da área do antro e volume gástrico e relação do volume gástrico sobre o peso (vol.p-1), cujo valor acima de 1,5 mL.kg-1 foi considerado risco para broncoaspiração. Considerou-se p< 0,05 como estatisticamente significativo. Resultados: Houve diferença significativa entre todos os parâmetros avaliados 2 horas após a ingestão de suplementação nutricional em relação ao jejum. O mesmo ocorreu quando foram comparados os parâmetros entre solução isotônica e suplementação nutricional 2 horas após a ingestão. Apenas um paciente apresentou vol.p-1< 1,5 mL.kg-1 2 horas após a ingestão de suplementação nutricional; e apenas um apresentou vol.p-1 > 1,5 mL.kg-1, após a ingestão de solução isotônica. Conclusão: Este estudo demonstrou que o esvaziamento gástrico de volumes iguais de diferentes soluções depende de sua constituição. Aqueles com alto valor calórico e alta osmolaridade, e com proteínas presentes, 2 horas após a ingestão, aumentaram os volumes gástricos, compatíveis com o risco de aspiração gástrica.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Ultrasonography/methods , Dietary Supplements , Gastric Emptying/physiology , Isotonic Solutions/administration & dosage , Osmolar Concentration , Stomach/diagnostic imaging , Energy Intake/physiology , Carbohydrates/administration & dosage , Proteins/administration & dosage , Prospective Studies , Fasting/psychology , Electrolytes/administration & dosageABSTRACT
Abstract Background and objectives: The current preoperative fasting guidelines allow fluid intake up to 2 h before surgery. The aim of this study was to evaluate the gastric volume of volunteers after an overnight fast and compare it with the gastric volume 2 h after ingestion of 200 and 500 mL of isotonic solution, by means of ultrasound assessment. Method: Eighty volunteers underwent gastric ultrasound at three times: after 8 h of fasting; 2 h after ingestion of 200 mL isotonic saline, followed by the first scan; and on another day, 2 h after ingestion of 500 mL of the same solution after an overnight fast. The evaluation was quantitative (antrum area and gastric volume, and the ratio of participants' gastric volume/weight) and qualitative (absence or presence of gastric contents on right lateral decubitus and supine positions. A p-value < 0.05 was considered significant). Results: There was no difference in quantitative variables at measurement times (p > 0.05). Five volunteers (6.25%) had a volume/weight over 1.5 mL kg-1 at fasting and 2 h after ingestion of 200 mL and 6 (7.5%) after 500 mL. Qualitatively, the presence of gastric fluid occurred in more volunteers after fluid ingestion, especially 500 mL (18.7%), although not statistically significant. Conclusion: Ultrasound assessment of gastric volume showed no significant difference, both qualitative and quantitative, 2 h after ingestion of 200 mL or 500 mL of isotonic solution compared to fasting, although gastric fluid content has been identified in more volunteers, especially after ingestion of 500 mL isotonic solution.
Resumo Justificativa e objetivos: As diretrizes recentes de jejum pré-operatório permitem a ingestão de líquidos até 2 horas antes da cirurgia. O objetivo do presente estudo foi, por meio de ultrassonografia gástrica, avaliar o volume gástrico de voluntários após jejum noturno e comparar com o volume gástrico duas horas após a ingestão de 200 e 500 ml de solução isotônica. Método: Foram submetidos à ultrassonografia gástrica 80 voluntários em três momentos: após jejum de 8 horas; 2 horas após a ingestão de 200 ml de solução isotônica, seguida do primeiro exame; e, em outro dia, 2 horas após a ingestão de 500 ml da mesma solução, após jejum noturno. A avaliação foi quantitativa (área do antro e volume gástricos e relação volume gástrico/peso dos participantes) e qualitativa, pela ausência ou presença de conteúdo gástrico nas posições de decúbito lateral direito e supina. Foi considerado significante p < 0,05. Resultados: Não houve diferença nas variáveis quantitativas nos três momentos estudados (p > 0,05). Cinco voluntários (6,25%) apresentaram um volume/peso superior a 1,5 ml.kg-1 em jejum e 2 horas após a ingestão de 200 ml e seis (7,5%) após 500 ml. Qualitativamente, a presença de líquido gástrico ocorreu em mais voluntários após a ingestão de líquidos, principalmente de 500 ml (18,7%), embora sem significância estatística. Conclusão: O volume gástrico pela ultrassonografia não apresenta diferença significativa tanto qualitativa quanto quantitativa, 2 horas após a ingestão de 200 ml ou de 500 ml de solução isotônica em comparação com o jejum, embora conteúdo líquido gástrico tenha sido identificado em mais voluntários, principalmente após a ingestão de 500 ml de solução isotônica.