الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 85 |  |  |
| | | from | 85 | | |
Abstract
O
ne of the main problems facing anesthesiologists during anesthesia is delayed gastric emptying which may contribute to pulmonary aspiration. Perioperative aspiration of gastric contents is a rare but serious complication of anesthesia. Pulmonary aspiration is involved in up to 9% of all anesthesia-related deaths. One of the main risk factors for aspiration is the presence of residual gastric fluid at the time of anesthetic induction. It was demonstrated that bedside utrasonography can provide reliable qualitative and quantitative information about the nature (fluid or solid) and volume of gastric content.
As data on the validity (i.e. accuracy) and reliability (i.e. reproducibility) of gastric sonography become increasingly available, the next important question is how to best incorporate this new diagnostic tool into daily clinical practice to assess aspiration risk and tailor anesthetic management in appropriate cases. We envision this tool to be useful in many clinical situations in which aspiration risk is unclear or undetermined.
The present study was undertaken to see whether the assumption of 8 hours was an adequate time for the stomach to empty in patients who had co-morbidities ( like Diabetes mellitus, chronic kidney disease ) with suspected delayed gastric emptying. We used the ultrasound machine as the point-of-care tool as it was portable and easily available.We compared ultrasound findings with the aspirated gastric volume done through nasogastric tube inserted post induction of general anesthesia.
Our study involved 85 patients, with mean age 49.1±10.16 years with mean BMI 32.16 ± 1.96 kg/m2. Forty nine of them were females (57.6 %) and 36 were males (42.4 %).Regarding patients’ physical status 7 of them were ASA I, 73 of them were ASA II and 5 of them were ASA III. Surgeries involved in the study were 48 general surgeries, 11 urology, 9 plastic surgeries, 6 vascular surgery, 5 orthopedics, 4 neurosurgery, 1 gynecological and 1 ENT. Regarding associated co-morbidities in patients involved in our study, 55 patients were diabetic, 11 of them had hypertension, 34 of them were smokers, 7 of them were hypothyroid, 7 of them had chronic kidney disease, 3 of them had rheumatoid arthritis. All patients were examined in both supine and RLD ( right lateral decubitus), forty-six of patients had empty stomach in both views, where 36 of them had empty stomach in supine position and fluid content in RLD and 3 of them had fluid content in both supine and RLD positions. The mean of RLD CSA (cross-sectional area) was 3.53 cm ± 1.06. So, 46 of the patients were classified as grade 0 (the antrum appears empty on both supine and right lateral decubitus), 36 of them classified as grade 1(gastric fluid is visible on the right lateral decubitus) and 3 of them as grade 2 (gastric fluid is observed in the antrum in both supine and right lateral decubitus).
It was found that ultrasound is of a good value in detecting gastric volume in patients with delayed gastric emptying as There was a strong positive relationship between the aspirated volume from nasogastric tube and volume estimated by ultrasound, with pearson’s correlation coefficient (r) of 0.992 and statistically non-significant difference between both of them (P-value 0.538). This means that ultrasound is of a good value in detecting gastric volume in patients with delayed gastric emptying.
In conclusion, ultrasound can be used to asses if patients can be anesthetized without exposure to risk of pulmonary aspiration resulting from delayed gastric emptying before induction of general anesthesia. It would be useful in many clinical situations in which aspiration risk is unclear or undetermined and we hope it will eventually become a standard of care.