Comorbidities and Pre-operative Gastric Ultrasound Assessment

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The inhalation of gastric (stomach) contents in to the lungs (pulmonary aspiration) has significant morbidity and mortality and can attribute to up to 9% of anaesthetic related deaths. [1] [2] In a large retrospective analysis, pulmonary aspiration occurs between 1:900 emergency patients and one in 3900 elective patients [3] A key risk factor for pulmonary aspiration is the volume of the aspirated gastric content. In certain subgroups of patients such as those with trauma, pulmonary aspiration can be as high has 34%. [4] Preoperative fasting guidelines aim to reduce the risk of pulmonary aspiration for the majority of patients undergoing anaesthesia. This is normally 6 hours for solid food and 2 hours for clear fluids in our institution (Royal Perth Hospital). Despite these guidelines there remain high risk groups in whom significant residual gastric volumes can remain despite adequate fasting - this is because they take longer to clear their gastric contents. These include patients with diabetes, liver or kidney dysfunction or pregnancy and trauma patients. [5] Previous methods for determining gastric content preoperatively have been invasive and lengthy procedures. Non-invasive gastric ultrasound however can now reliably estimate gastric volume and content. [5] [6] Ultrasound represents a convenient bedside portable tool that can be used to help guide anaesthetists managing the anaesthetic risk for these high risk groups. This prospective cohort study aims to quantify the risk of aspiration by gastric volumes for those with renal dysfunction, emergency or urgent surgery, diabetes, gastro-oesophageal reflux disease (GORD) and obesity as indicated by preoperative gastric ultrasound using a standardised technique [1, 5] 1. Perlas, A., et al., Ultrasound assessment of gastric content and volume. Anesthesiology. 111(1): p. 82-9. 2. Landreau, B., I. Odin, and N. Nathan, [Pulmonary aspiration: epidemiology and risk factors]. Ann Fr Anesth Reanim, 2009. 28(3): p. 206-10. 3. Warner, M.A., M.E. Warner, and J.G. Weber, Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology. 1993. 78(1): p. 56-62. 4. Lockey, D.J., T. Coats, and M.J. Parr, Aspiration in severe trauma: a prospective study. Anaesthesia. 54(11): p. 1097-8. 5. Perlas, A., et al., Gastric sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg, 2011. 113(1): p. 93-7.

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