Qualitative and quantitative gastric ultrasound assessment in highly skilled regional anesthesiologists

Rattanaporn Tankul, Pathom Halilamien, Suwimon Tangwiwat, Sukanya Dejarkom, Pawinee Pangthipampai, Rattanaporn Tankul, Pathom Halilamien, Suwimon Tangwiwat, Sukanya Dejarkom, Pawinee Pangthipampai

Abstract

Background: Pulmonary aspiration is a major complication in anesthesia, and various studies have shown that gastric sonography can reliably provide valuable information relative to both the qualitative and quantitative aspects of gastric content. This study aimed to determine the accuracy of ultrasound assessment of gastric content compared between two novice anesthesiologist gastric sonographers.

Methods: This prospective cohort study of two anesthesiologists learning to perform qualitative and quantitative ultrasound assessment of gastric content on healthy volunteers was conducted at Siriraj Hospital (Bangkok, Thailand). This trial was registered with ClinicalTrials.gov (reg. no. NCT04760106).

Results: Of the 50 enrolled participants, three were excluded due to study protocol violation. Each anesthesiologist performed a qualitative assessment on 47 participants for an overall total of 94 scans. There were 15 males and 32 females (age 42 ± 11.7 years, weight 61.2 ± 13.1 kg, height 160.7 ± 7.3 cm, and BMI 23.6 ± 4.3 kg/m2). The overall success rate for all gastric content categories was approximately 96%. From antral cross-sectional area measurement, as the ingested volume increased, there was a tendency toward increased deviation from the actual ingested volume. Interrater agreement between anesthesiologists was analyzed using intraclass correlation coefficients (ICCs). A larger fluid volume was found to be associated with a lower level of agreement between the two anesthesiologists. The ICCs were 0.706 (95% CI: -0.125 to 0.931), 0.669 (95% CI: -0.254 to 0.920), 0.362 (95% CI: -0.498 to 0.807) for the 100 ml, 200 ml, and 300 ml fluid volumes, respectively. The mean duration to perform an ultrasound examination for each gastric content category and for the entire examination did not differ significantly between anesthesiologists (p > 0.05).

Conclusion: Our results indicate that qualitative ultrasound assessment of gastric content is highly accurate and can be easily learned. In contrast, quantification of gastric volume by novice gastric sonographers is more complex and requires more training.

Trial registration: ClinicalTrials.gov no. NCT04760106 Date registered on Feb 11, 2021. Prospectively registered.

Keywords: Gastric content; Gastric volume; Novice anesthesiologist gastric sonographers; Qualitative ultrasound assessment; Quantification; Training.

Conflict of interest statement

All authors declare no personal or professional conflicts of interest, and no financial support from the companies that produce and/or distribute the drugs, devices, or materials described in this report.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Cumulative sum (CUSUM) control chart graph of the learning curves of the two anesthesiologists. Each point represents a consecutive gastric scan. For each scan, the graph descends by s for each successful attempt, and ascends by 1-s for each failed attempt

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