Respiratory Aspiration of Gastric Content
Conditions
Keywords
prone position, Gastric POCUS (Point of Care Ultrasound), antrum diameter, risk of pulmonary aspiration, different peep levels
Brief summary
The aim of this study was to predict the effect of gastric antrum diameter before extubation on intra-abdominal pressure changes and consequently on the risk of pulmonary aspiration in patients undergoing elective spinal surgery under general anaesthesia in the prone position in the Neurosurgery Operating Theatre of the Ministry of Health Ankara City Hospital and to take precautions accordingly. Gastric antrum diameter and intraabdominal pressure measurements may contribute to the improvement of anaesthetic practice by reducing the risk of pulmonary aspiration and additional complications.
Detailed description
Prone positioning in spinal surgery is a very important issue for anaesthetists. Although there are many conditions that are taken into consideration in patient follow-up, it is a position frequently used in the treatment of pulmonary diseases other than surgery. PEEP application in the prone position is especially used in the treatment of conditions such as acute respiratory distress syndrome (ARDS). This treatment method basically aims to improve oxygenation and ventilation in the lungs. While providing improvement in the lungs, it may indirectly lead to some changes in the gastrointestinal system. Depending on PEEP levels, intra-abdominal pressure may increase and subsequently cause reflux of gastric contents or gastroparesis. The prone position itself also increases the risk of reflux. Gastric POCUS (Point of Care Ultrasound) is a noninvasive method that gives us information about the stomach contents and can be easily performed at the bedside. Both patient position and respiratory parameters, such as PEEP, may have an effect on gastric POCUS. Visualization of gastric content or detection of gastric retention allows us to predict possible pulmonary aspiration complications before extubation, and gastric POCUS may be a valuable marker before extubation in patients who remain in prone positions for a long time. The aim of this study was to determine the effect of PEEP application on the antrum diameter evaluated by gastric POCUS and the risk of aspiration before extubation in patients undergoing spinal surgery in the prone position.
Interventions
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
single blind
Intervention model description
We gave three different peep values on the mechanic ventilator; 3 groups: Group I: PEEP O, Group II: PEEP 4, Group III: PEEP 8
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* 18-65 years of age * ASA I-II risk group
Exclusion criteria
* Asthma * COPD * Gastroesophageal reflux * Gastric herniation * Gastric surgery, * Intracranial tumor * Epilepsy * Neuromuscular disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gastric antrum diameter | induction of anaesthesia at 0 minutes,After induction of anaesthesia at 1 minutes,at 10 minutes at the end of the case | Cross-sectional area (CSA) (cm2) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraabdominal pressure (IAP) measurement | induction of anaesthesia at 0 minutes,After induction of anaesthesia at 1 minutes,at 10 minutes at the end of the case | Comparing IAP between three groups. |
| gastric volume measurement | induction of anaesthesia at 0 minutes,After induction of anaesthesia at 1 minutes,at 10 minutes at the end of the case | gastric volume (ml) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Vital parameters Pulse oximetry (%) | induction of anaesthesia at 0 minutes,After induction of anaesthesia at 1 minutes,at 10 minutes at the end of the case | Pulse oximetry (%) |
| Vital parameters systolic and diastolic blood pressure (mmHg) | induction of anaesthesia at 0 minutes,After induction of anaesthesia at 1 minutes,at 10 minutes at the end of the case | systolic and diastolic blood pressure (mmHg) |
| Vital parameters heart rate (beats/minute) | induction of anaesthesia at 0 minutes,After induction of anaesthesia at 1 minutes,at 10 minutes at the end of the case | heart rate (beats/minute) |
Countries
Turkey (Türkiye)
Outcome results
None listed