Background and Aims Aspiration accounts for 50% of anaesthesia related deaths. Inadequate pre-operative risk assessment is one of the contributing factors1. Point-of-care gastric ultrasound (POC-USG) is a novel but valid diagnostic tool to quantify gastric volume (GV) and ascertain risk of aspiration2.
The aims of our project were to determine, in fasted patients undergoing emergency surgery:
if quantitative and qualitative methods of assessment of gastric volume (GV) correlate with each other
if GV assessment identifies at high risk of aspiration, and
if higher risk of aspiration was identified, whether this changed the plan for airway management
Methods Patients booked onto the emergency list were prospectively scanned using low frequency 1–5MHz curvilinear transducer. GV was estimated by inputting cross sectional area of the antrum in the right lateral decubitus position (RLD-CSA) into a validated model2. This was compared to acceptable GV determined by the patient’s weight (low risk for aspiration = <1.5 ml kg-1; high risk >1.5 ml kg-1)2. Qualitative assessment was categorised as grade 0–2 based on antrum appearance. Risk was communicated to the anaesthetist and the final airway plan recorded.
Results There was 100% (n=15) correlation between qualitative and quantitative methods. 3 were identified at high risk of aspiration (GV >1.5 ml kg-1). All these patients were fasted >6h. 2 had a change in airway plan and 1 patient was undergoing a regional technique.
Conclusions Fasting >6h does not always preclude a high risk of aspiration. POC-USG can aid decision-making as part of a multi-modal assessment of aspiration risk to improve patient safety. Ethics approval not required.