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Abstract
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Background and Aims Broncoaspiration pneumonia is a complication of anesthetic management because of aspiration of gastric content into the airway. It’s an important cause of morbidity and mortality. To avoid it, patients who undergo surgery are subjected to a 6h fasting for solids and 2h for clear fluids. Ultrasound of the gastric antrum allows a quick and innocuous evaluation of its dimensions at the bedside, which correlates with the volume of intragastric fluid. Our aim is to detect the patient with full stomach despite the 6h fasting and thus assess the risk/benefit of performing the intervention as well as modifying the anesthetic management in each case.
Methods Bedside gastric ultrasound was performed on 3 patients who were about to undergo surgery and submitted to 6h hours fasting for solids and 2h for clear fluids.
Results We present a 3 case-serie of patients in which the manage of induction of general anesthesia was modified because of the findings in our assesment of gastric content. Two of them were proposed for a rapid induction sequency and the other needed to delay surgery to assure an adequate gastric emptying prior to the intervention.
It shows liver parenchyma on the left side of the image, followed by a large cystic image presumably dependent on the pancreas. We can also observe the dilated gastric antrum with apparent solid hyperechogenic content inside
The image shows a hyperechogenic figure which projects posterior acoustic shadow. This is considered highly suggestive of full stomach
Hepatic parenchyma is evident to the left, hypoechogenicity in the lower part of the picture corresponding to the Superior vena Cava. Gastric antrum appears to be hyperechogenic with heterogeneous solid content. Transectional area of gastric antrum was measured and that revealed an area of 16.12 cm2. According to the equation proposed by Perlas et al (1.27.0 + 14.6 × ACSA*-1.28 × age), resulted in an approximation of 213 ml. This amount is higher than it is considered safe for general anesthesia induction. *Antrum Crossectional Area
Conclusions The use of gastric ultrasound to visualize the gastric antrum prior to surgical intervention is a quick technique that is safe for patients and can be useful to identify those who are at risk and consequently need adequate anesthetic management as a full stomach status.
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