Preoperative assessment of gastric contents and volume using bedside ultrasound in adult patients: A prospective, observational, correlation study

Garima Sharma, Rebecca Jacob, Subramanyam Mahankali, M N Ravindra, Garima Sharma, Rebecca Jacob, Subramanyam Mahankali, M N Ravindra

Abstract

Background and aims: Pulmonary aspiration of gastric contents is a serious complication of anaesthesia. The aim of this study was to determine, with the help of ultrasound, the gastric volume and content in fasted patients presenting for elective surgeries and correlate the results with fasting times and co-morbidities of the patients.

Methods: The study was conducted in 100 adult patients presenting for elective surgery. A preoperative bedside gastric ultrasound scan was done in supine and right lateral position. Gastric contents were noted, and gastric volume was calculated at the level of the gastric antrum. Gastric volume was estimated by measuring antral cross-sectional area (CSA) and using a mathematical model. Gastric volume in the right lateral decubitus (RLD) position was taken as the final reading. Analysis of variance and Student's t-test were done for statistical significance and P < 0.05 was considered statistically significant.

Results: Six out of 100 patients had solid gastric contents and 16 had >1.5 ml/kg clear liquids, although they had been fasting between 10 and 15 hours. Patients suffering from diabetes and chronic kidney disease had statistically significant increase in CSA in both supine and RLD. We also found increase in estimated gastric volume as the BMI of the patients increased.

Conclusion: Our study showed that fasting for more than 6-10 hours does not guarantee an empty stomach. Those with co-morbidities like diabetes mellitus, obesity and chronic kidney disease (CKD) appear more prone to have unsafe gastric contents.

Keywords: Gastric antrum; gastric content; gastric ultrasound; gastric volume; point-of-care; ultrasound.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Scanning positions: (a) supine and (b) right lateral
Figure 2
Figure 2
Still image of the antrum (empty with bulls eye appearance) (a) and coloured depiction of organs and cross sectional area calculation by using the free tracing tool (b)
Figure 3
Figure 3
Appearance of gastric antrum with clear liquids (a), clear liquids with gas (starry sky appearance) (b), solids with blurring of posterior wall (c) and frank solids (d)

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