Pulmonary aspiration of gastric content is a serious perioperative complication. The objective of this prospective study was to assess the relationship between the gastric volumes suctioned endoscopically and quantitative (antral cross-section area) and qualitative (empty vs. nonempty) examination of the gastric antrum. Furthermore, the study aimed to determine the best antral cross-section area cutoff value for a truly empty antrum in infants.
This study was performed in a pediatric gastrointestinal endoscopy unit. Antral sonography was performed in supine and right lateral decubitus positions in 46 fasted infants prior to upper gastrointestinal endoscopic evaluation. Antral cross-sectional area measurements in both positions and qualitative evaluation of the antrum (according to a three-point grading system) were recorded. Gastric contents were endoscopically suctioned and measured.
Forty-six patients (aged under 24 months) were included. According to the three-point qualitative grading system, 76.1% of patients were classified as grade 0. The best cutoff value for the antral cross-section area in the right lateral decubitus position, indicating an empty antrum, was determined to be 2.40 cm2. At this specific cutoff value, the sensitivity was 100%, the specificity was 68.6%, and the negative predictive value was 100%.
Gastric ultrasonography can confirm an empty or nearly empty stomach in healthy infants.

BACKGROUND: In the intensive care unit (ICU), a fasting period is usually respected to avoid gastric aspiration during airway management procedures. Since there are no recognised guidelines, intensive care physicians balance the aspiration risk with the negative consequences of underfeeding. Our objective was to determine the impact of fasting on gastric emptying in critically ill patients by using gastric ultrasound.
METHODS: Among the 112 patients that met the inclusion criteria, 100 patients were analysed. Gastric ultrasonography was performed immediately before extubation. Patients with either 1/ an absence of visualised gastric content (qualitative evaluation) or 2/ a gastric volume < 1.5 mll/kg in case of clear fluid gastric content (quantitative evaluation) were classified as having an empty stomach.
RESULTS: In our study, twenty-six (26%) patients had a full stomach at the time of extubation. The incidence of full stomach was not significantly different between patients who fasted < 6 h or patients who fasted ≥ 6 h. Among the 57 patients receiving enteral nutrition (EN) within the last 48 h, there was no correlation between the duration of EN interruption and the GAA. The absence of EN was not associated with an empty stomach.
CONCLUSIONS: At the time of extubation, the incidence of full stomach was high and not associated with the fasting characteristics (duration/absence of EN). Our results support the notions that fasting before airway management procedures is not a universal paradigm and that gastric ultrasound might represent a useful tool in the tailoring process. CLINICALTRIALS.GOV: NCT04245878.

UNASSIGNED: Rapid sequence induction and intubation (RSII) with application of \"Cricoid pressure\" and avoidance of \"facemask ventilation\" (FMV) is believed to minimize the risk of pulmonary aspiration of gastric contents during general anesthesia. However, some patients may be at risk of developing hypoxemia and may benefit from FMV during RSII. The purpose of this study was to assess the effectiveness of \"cricoid pressure\" in preventing gastric insufflation during FMV using gastric ultrasonography.
UNASSIGNED: Eighty-four adult patients were randomized to receive cricoid pressure (CP) or no cricoid pressure (NCP), during FMV after induction of general anesthesia. Gastric antral cross-sectional area (CSA) was measured with ultrasonography before and after FMV in supine and right lateral decubitus positions (LDP). Appearance of \"comet tail\" artifacts created by acoustic shadows of gas in the gastric antrum was noted.
UNASSIGNED: The incidence of insufflation indicated by \"comet tail\" artifacts during FMV was lower in group CP (17 vs 71%; P < 0.001). The lowest P aw at which gastric insufflation occurred was higher in group CP (20 vs 14 cmH2O). The change in mean gastric antral CSA was significantly lower in group CP than in group NCP in supine (0.02 vs 0.36 cm2, P = 0.012) and right LDP (0.03 vs 0.67 cm2, P < 0.001).
UNASSIGNED: Cricoid pressure is effective in preventing gastric insufflation during FMV at P aw less than 20 cmH2O. Observation of comet tail artifacts in gastric antrum along with measurement of change in antral CSA on ultrasound examination is a feasible and reliable method to detect gastric insufflation.

BACKGROUND: Emergency situations and conditions with impaired gastric emptying enhance the risk of perioperative pulmonary aspiration due to increased residual gastric contents volume (GCV). Gastric ultrasonographic (US) measurement of the gastric antral cross-sectional area (CSA) has been proposed to estimate preanesthetic GCV. However, only few healthy children and fasted pediatric patients have been investigated so far, predicting GCV with considerable imprecision. This study aimed to compare GCV assessed by US in different patient positions for measuring CSA, using magnetic resonance imaging (MRI) as reference, and to evaluate its potential as diagnostic test.
METHODS: Healthy volunteer children were examined in a crossover design on 2 days. After baseline examination, they received a light breakfast, followed by 7 ml·kg-1 clear fluid after 2 or 4 h. Gastric emptying was examined with MRI over 4 or 6 h, respectively. US was performed immediately after MRI in right lateral decubital (RLD) and supine with upper body elevated (SUBE) positions. Correlation coefficients (Pearson R; 95%CI) between CSA and body weight corrected GCV (GCVw ) as determined by MRI volumetry were calculated. Data are presented as median (range).
RESULTS: Eighteen children aged 9.8 (6.8-12.2) years had 72 US examinations completed. CSA was 401 (101-1311) mm2 and 271 (118-582) mm2 , and R between CSA and GCVw was 0.76 (0.76-1) and 0.57 (0.41-0.88) for the RLD and SUBE positions, respectively. The corresponding GCVw was 2.1 (0.1-13.8) ml·kg-1 . A linear regression model from RLD was similar to one previously derived. Bland-Altman analysis and ROC plots are presented.
CONCLUSIONS: CSA correlated with GCVw in healthy children over a wide range of gastric filling, with the RLD position clearly superior to the SUBE position, confirming a previously derived formula. Although direct calculation of GCVw is imprecise, this technique has the potential to become a diagnostic risk assessment test.