Point-of-care ultrasound defines gastric content and changes the anesthetic management of elective surgical patients who have not followed fasting instructions: a prospective case series

• Published in: Canadian journal of anesthesia 2015-11, Vol.62 (11), p.1188-1195
• Main Authors: Alakkad, Husni, Kruisselbrink, Richelle, Chin, Ki Jinn, Niazi, Ahtsham U., Abbas, Sherif, Chan, Vincent W. S., Perlas, Anahi
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia - methods; Anesthesiology; Cardiology; Cohort Studies; Critical Care Medicine; Elective Surgical Procedures; Fasting; Female; Gastrointestinal Contents; Gastrointestinal Tract - diagnostic imaging; Humans; Intensive; Male; Medical personnel; Medicine; Medicine & Public Health; Middle Aged; Mortality; Pain Medicine; Patient Compliance; Patients; Pediatrics; Pneumology/Respiratory System; Point of care testing; Point-of-Care Systems; Prospective Studies; Pulmonary aspiration; Reports of Original Investigations; Research ethics; Ultrasonic imaging; Ultrasonography; Young Adult
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-015-0449-1

Purpose Pulmonary aspiration of gastric contents is a major cause of anesthesia morbidity and mortality. Point-of-care gastric ultrasound provides information regarding the type and volume of gastric content. The hypothesis of this prospective cohort study was that the addition of point-of-care gastric ultrasound to standard patient assessment results in changes in anesthetic management in at least 30% of elective surgical patients who do not follow fasting instructions. Methods Following Research Ethics Board approval and informed consent, elective surgical patients who did not follow fasting instructions were included in this prospective study. Documentation included the type of food ingested, the timing of the ingestion relative to the planned surgical time, and the treating anesthesiologist’s management plan based on history alone. Next, an independent anesthesiologist not involved in the medical decision-making performed a focused gastric ultrasound examination. The results of the ultrasound exam were documented in a standardized fashion and made available to the attending anesthesiologist who then confirmed or revised the initial management plan. The treating anesthesiologist’s actual (post-test) patient management was documented in a standardized fashion and compared with the initial (pre-test) management plan. Results Thirty-eight patients were included in this case series. Following point-of-care gastric ultrasound, there was a change in either the timing of anesthesia or the anesthetic technique (or both) in 27 patients (71%), with a net change towards a lower incidence of surgical delays. Conclusions This prospective case series suggests that a standardized point-of care gastric ultrasound examination informs anesthesiologists’ perceived level of aspiration risk and leads to changes in anesthetic management in a significant proportion of elective patients who did not follow fasting instructions.