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Abstract
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Background and Aims The timing and technique of anesthesia are challenging in patients with a history of recent food intake. The presence of gastric content 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 to estimate residual gastric content and guide decision-making in airway management and timing of general anesthesia. We reviewed 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 adult patients scheduled for emergency surgery.
Results Five prospective observational studies representing 793 patients showed an incidence of a ‘full stomach’ between 18 and 56% in the emergency surgery population at the time of induction. Risk factors for a full stomach in emergency surgery were abdominal or gynecological/obstetric surgery, high body mass index and morphine consumption. No correlation between preoperative fasting time and the presence of a full/empty stomach was shown. No deaths due to aspiration were reported.
Gastric ultrasound
Medical decision-making flowchart
Conclusions The presence of preoperative gastric content in the emergency surgery is high and the clinical estimation is unreliable. Our findings demonstrated that gastric ultrasound is a valuable tool to evaluate the presence of gastric content. Moreover, a flowchart for medical decision-making using gastric ultrasound for emergency surgery patients was developed to assist in clinical decision-making.