■术前药物预防在全身麻醉(GA)下预防吸入性肺炎低风险患者吸入性肺炎中的作用仍在争论中。我们通过使用有和没有药理酸吸入预防的超声评估胃体积的变化,解决了在高危人群中常规药理吸入预防的需求。
■单中心,随机双盲试验,有200名成年患者计划在GA下进行择期外科手术,被随机分为预防组,患者口服法莫替丁和甲氧氯普胺,和一个没有预防的组,其中患者没有接受任何预防。通过超声对胃窦体积的预诱导测量得出的胃体积,诱导后胃pH,并比较吸入性肺炎的发生率。Bland-Altman图用于根据计算的胃体积确定测得的胃体积与超声检查之间的一致性水平。
■无预防组的胃窦横截面积(CSA)和体积(3.12cm2和20.11ml,分别)与预防组(2.56cm2和19.67ml,分别)(P值分别为0.97和0.63)。尽管无预防组的胃pH值在统计学上有显着下降(P值0.01),根据Roberts和Shirley标准,增加吸入性肺炎的风险无临床意义(P值0.39).
■在足够禁食的低风险人群中,残余胃体积的量相似,低于抽吸阈值,无论吸入预防状况如何。
UNASSIGNED: The role of preoperative pharmacological prophylaxis in preventing aspiration pneumonitis under general anesthesia (GA) in patients at low risk of aspiration pneumonitis is still under debate. We addressed the need for routine pharmacological aspiration prophylaxis in at-risk population by assessing the change in gastric volume using ultrasound with and without pharmacological acid aspiration prophylaxis.
UNASSIGNED: A single-center, randomized double-blinded trial, with 200 adult patients scheduled for elective surgical procedures under GA, were randomized into a prophylaxis group, in which the patients received oral famotidine and metoclopramide, and a no prophylaxis group, in which the patients did not receive any prophylaxis. Gastric volume derived from preinduction measurement of gastric antral volume by ultrasound, postinduction gastric pH, and incidences of aspiration pneumonitis were compared. Bland-Altman plot was used to determine the level of agreement between measured gastric volume and ultrasonography based on calculated gastric volume.
UNASSIGNED: The gastric antral cross-sectional area (CSA) and volume in the no prophylaxis group (3.12 cm2 and 20.11 ml, respectively) were comparable to the prophylaxis group (2.56 cm2 and 19.67 ml, respectively) (P-values 0.97 and 0.63, respectively). Although there was a statistically significant decrease in gastric pH in the no prophylaxis group (P-value 0.01), it was not clinically significant to increase the risk of aspiration pneumonitis based on Roberts and Shirley criteria (P-value 0.39).
UNASSIGNED: In an adequately fasted low-risk population, the amount of residual gastric volume was similar and below the aspiration threshold, regardless of the aspiration prophylaxis status.