Alakkad Husni, Kruisselbrink Richelle, Chin Ki Jinn, Niazi Ahtsham U, Abbas Sherif, Chan Vincent W S, Perlas Anahi
Department of Anesthesia, Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
University of Dammam, Dammam, Saudi Arabia.
Can J Anaesth. 2015 Nov;62(11):1188-95. doi: 10.1007/s12630-015-0449-1. Epub 2015 Aug 4.
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.
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.
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.
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.
胃内容物的肺误吸是麻醉并发症和死亡的主要原因。床旁胃超声可提供有关胃内容物类型和容量的信息。这项前瞻性队列研究的假设是，在标准患者评估中增加床旁胃超声检查，会使至少30%未遵循禁食指示的择期手术患者的麻醉管理发生改变。
在获得研究伦理委员会批准并取得知情同意后，未遵循禁食指示的择期手术患者被纳入这项前瞻性研究。记录内容包括摄入食物的类型、摄入时间与计划手术时间的关系，以及仅基于病史的主治麻醉医生的管理计划。接下来，一名未参与医疗决策的独立麻醉医生进行了重点胃超声检查。超声检查结果以标准化方式记录，并提供给主治麻醉医生，后者随后确认或修订初始管理计划。主治麻醉医生实际（检查后）的患者管理以标准化方式记录，并与初始（检查前）管理计划进行比较。
本病例系列纳入了38例患者。床旁胃超声检查后，27例患者（71%）的麻醉时间或麻醉技术（或两者）发生了改变，手术延迟发生率总体呈下降趋势。
这项前瞻性病例系列研究表明，标准化的床旁胃超声检查能让麻醉医生了解误吸风险程度，并导致相当一部分未遵循禁食指示的择期手术患者的麻醉管理发生改变。
