Abstract：
BACKGROUND: Aspiration pneumonitis remains a dreaded complication that may lead to almost 9% of anaesthesia-related deaths. The presence of gastric contents has always been a contributing factor to an increased risk of aspiration. Preoperative gastric ultrasound has been suggested as a modality for determining residual volume in special populations and conditions. We conducted an observational study to determine the gastric residual volume in preoperative patients of elective surgery with gastric ultrasound and to study its correlation with patient factors.
METHODS: We enrolled 411 patients in the age group of 18-80 with ASA-PS I and II having BMI less than 35 kg/m2. Patients with prior gastrointestinal surgery and parturients were excluded from the present study. Gastric antrum in both supine and right lateral decubitus positions was measured using USG in the immediate preoperative period, and gastric residual volume was calculated, which was subsequently correlated with various patient factors.
RESULTS: On qualitative assessment, 97 and 118 patients were observed to have distended stomachs in the supine and right lateral decubitus positions, respectively. On quantitative assessment, 336 had safe GRV, 60 patients were classified as having a low risk of aspiration (GRV < 1.5 ml/kg) while 13 had a high risk of aspiration (> 1.5 ml/kg). Eight patients with a fasting duration of more than ten hours and five who fasted between 6 and 10 h had a gastric residual volume of more than 1.5 ml/h. Patients who were premedicated with histamine blockers had a statistically significant higher antral cross-sectional area (p-value - 0.022*) and GRV (p-value - 0.018*) in the right lateral decubitus position compared to patients who had taken proton pump inhibitors (PPIs). As BMI increased, there was a statistically significant (p-value < 0.001) increase in mean antral CSA in both supine and right lateral decubitus positions. There was a statistically significant association found between type 2 diabetes (p-value 0.045*) with antral grade.
CONCLUSIONS: Patients can have significant residual volume (> 1.5 ml/kg) despite adequate fasting, and preoperative gastric ultrasound can help in assessing the same and guiding perioperative airway management. PPIs are more effective in reducing gastric residual volume as compared to histamine blockers. Patients with a BMI of more than 30 and type 2 diabetes mellitus have significant correlation with increased gastric residual volume mandating preoperative gastric ultrasound assessment for effective management.
CONCLUSIONS: Patients with BMI over 30 and type 2 diabetes may benefit from POCGUS to guide perioperative airway management by stratifying GRV. Trial registration Name of registry-Clinical Trial Registry of India. Trial registration number-2020/03/024083. Date of registration-19.3.2020. URL- http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=39961&EncHid=&userName=.
METHODS: We enrolled 411 patients in the age group of 18-80 with ASA-PS I and II having BMI less than 35 kg/m2. Patients with prior gastrointestinal surgery and parturients were excluded from the present study. Gastric antrum in both supine and right lateral decubitus positions was measured using USG in the immediate preoperative period, and gastric residual volume was calculated, which was subsequently correlated with various patient factors.
RESULTS: On qualitative assessment, 97 and 118 patients were observed to have distended stomachs in the supine and right lateral decubitus positions, respectively. On quantitative assessment, 336 had safe GRV, 60 patients were classified as having a low risk of aspiration (GRV < 1.5 ml/kg) while 13 had a high risk of aspiration (> 1.5 ml/kg). Eight patients with a fasting duration of more than ten hours and five who fasted between 6 and 10 h had a gastric residual volume of more than 1.5 ml/h. Patients who were premedicated with histamine blockers had a statistically significant higher antral cross-sectional area (p-value - 0.022*) and GRV (p-value - 0.018*) in the right lateral decubitus position compared to patients who had taken proton pump inhibitors (PPIs). As BMI increased, there was a statistically significant (p-value < 0.001) increase in mean antral CSA in both supine and right lateral decubitus positions. There was a statistically significant association found between type 2 diabetes (p-value 0.045*) with antral grade.
CONCLUSIONS: Patients can have significant residual volume (> 1.5 ml/kg) despite adequate fasting, and preoperative gastric ultrasound can help in assessing the same and guiding perioperative airway management. PPIs are more effective in reducing gastric residual volume as compared to histamine blockers. Patients with a BMI of more than 30 and type 2 diabetes mellitus have significant correlation with increased gastric residual volume mandating preoperative gastric ultrasound assessment for effective management.
CONCLUSIONS: Patients with BMI over 30 and type 2 diabetes may benefit from POCGUS to guide perioperative airway management by stratifying GRV. Trial registration Name of registry-Clinical Trial Registry of India. Trial registration number-2020/03/024083. Date of registration-19.3.2020. URL- http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=39961&EncHid=&userName=.
摘要：
背景：吸入性肺炎仍然是一种可怕的并发症，可能导致近9%的麻醉相关死亡。胃内容物的存在一直是增加误吸风险的促成因素。术前胃超声已被建议作为确定特殊人群和条件下残留量的一种方式。我们进行了一项观察性研究，以确定择期胃超声手术的术前患者的胃残留量，并研究其与患者因素的相关性。
方法：我们招募了411名年龄在18-80岁的ASA-PSI和II患者，其BMI小于35kg/m2。先前进行过胃肠道手术的患者和产妇被排除在本研究之外。术前即刻使用USG测量仰卧位和右侧卧位胃窦。并计算胃残留量，随后与各种患者因素相关。
结果：关于定性评估，观察到97和118例患者在仰卧和右侧卧位有胃扩张，分别。在定量评估上，336有安全的GRV，60名患者被分类为具有低误吸风险(GRV<1.5ml/kg),而13名患者具有高误吸风险(>1.5ml/kg)。8例禁食时间超过10小时的患者和5例禁食6至10小时的患者的胃残留量超过1.5ml/h。与服用质子泵抑制剂（PPI）的患者相比，接受组胺阻滞剂治疗的患者在右侧卧位的窦横截面积（p值-0.022*）和GRV（p值-0.018*）具有统计学意义。随着BMI的增加,仰卧位和右侧卧位的平均窦CSA均有统计学意义(p值<0.001)的增加.2型糖尿病（p值0.045*）与窦等级之间存在统计学上的显着关联。
结论：患者可以有显著的残余体积（>1.5ml/kg），尽管有足够的禁食，术前胃超声可以帮助评估和指导围手术期气道管理。与组胺阻断剂相比,PPI在减少胃残余体积方面更有效。BMI大于30的患者和2型糖尿病患者与胃残留量增加显著相关，要求术前进行胃超声评估以进行有效管理。
结论：BMI超过30和2型糖尿病的患者可能受益于POCGUS通过分层GRV指导围手术期气道管理。试验注册处名称-印度临床试验注册处。试用登记号-2020/03/024083。注册日期-19.3.2020。URL-http://ctri。nic.在/临床试验/pmaindet2。php?trialid=39961&EncHid=&userName=。
方法：我们招募了411名年龄在18-80岁的ASA-PSI和II患者，其BMI小于35kg/m2。先前进行过胃肠道手术的患者和产妇被排除在本研究之外。术前即刻使用USG测量仰卧位和右侧卧位胃窦。并计算胃残留量，随后与各种患者因素相关。
结果：关于定性评估，观察到97和118例患者在仰卧和右侧卧位有胃扩张，分别。在定量评估上，336有安全的GRV，60名患者被分类为具有低误吸风险(GRV<1.5ml/kg),而13名患者具有高误吸风险(>1.5ml/kg)。8例禁食时间超过10小时的患者和5例禁食6至10小时的患者的胃残留量超过1.5ml/h。与服用质子泵抑制剂（PPI）的患者相比，接受组胺阻滞剂治疗的患者在右侧卧位的窦横截面积（p值-0.022*）和GRV（p值-0.018*）具有统计学意义。随着BMI的增加,仰卧位和右侧卧位的平均窦CSA均有统计学意义(p值<0.001)的增加.2型糖尿病（p值0.045*）与窦等级之间存在统计学上的显着关联。
结论：患者可以有显著的残余体积（>1.5ml/kg），尽管有足够的禁食，术前胃超声可以帮助评估和指导围手术期气道管理。与组胺阻断剂相比,PPI在减少胃残余体积方面更有效。BMI大于30的患者和2型糖尿病患者与胃残留量增加显著相关，要求术前进行胃超声评估以进行有效管理。
结论：BMI超过30和2型糖尿病的患者可能受益于POCGUS通过分层GRV指导围手术期气道管理。试验注册处名称-印度临床试验注册处。试用登记号-2020/03/024083。注册日期-19.3.2020。URL-http://ctri。nic.在/临床试验/pmaindet2。php?trialid=39961&EncHid=&userName=。
