Bouvet Lionel, Bellier Nicolas, Gagey-Riegel Anne-Charlotte, Desgranges François-Pierrick, Chassard Dominique, De Queiroz Siqueira Mathilde
Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France.
INSERM, LabTAU UMR1032, University of Lyon, Université Claude Bernard Lyon 1, Centre Léon Bérard, Lyon, France.
Paediatr Anaesth. 2018 Oct;28(10):906-913. doi: 10.1111/pan.13472. Epub 2018 Sep 12.
Though pulmonary aspiration of gastric contents occurs mainly in the setting of emergency surgery, it may also occur in children scheduled for elective surgery without any obvious clinical risk factor. Increased gastric content volume is one the predisposing factors for pulmonary aspiration that could affect such children and may be identified using ultrasound examination of the gastric antrum.
We aimed to assess the prevalence of "at-risk stomach" defined by ultrasound visualization of any solid content in the antrum and/or by calculated gastric fluid volume > 1.25 mL/kg, in children scheduled for elective surgery.
Children scheduled for elective surgery were consecutively included into this prospective cohort study. Preoperative ultrasound examination of the antrum was performed in both the supine and the right lateral decubitus positions. Gastric fluid content was assessed using a 0-2 qualitative grading scale. The antral cross-sectional area was also measured in both the supine and the right lateral decubitus positions, allowing the calculation of the gastric fluid volume according to a formula previously described.
We analyzed 200 elective children. Median duration of fasting was 4 hours for liquids and >13 hours for solids. None of the children included in this study had evidence of solid content. Six (3%) children had a Grade 2 antrum (fluid content seen in both the supine and the right lateral decubitus positions). Two children had a gastric fluid volume >1.25 mL/kg. The prevalence of "at-risk stomach" was 1% (95% confidence interval: 0.2%-3.9%).
According to our results, only 1% of elective children had potentially increased risk for pulmonary aspiration. Further studies should be performed in order to define the target population of elective children for which ultrasound assessment of gastric content should be performed prior to general anesthesia.
尽管胃内容物的肺误吸主要发生在急诊手术中，但在计划进行择期手术的儿童中也可能发生，且无任何明显的临床危险因素。胃内容物体积增加是可能影响此类儿童的肺误吸诱发因素之一，可通过超声检查胃窦来识别。
我们旨在评估计划进行择期手术的儿童中，通过超声显示胃窦内有任何固体成分和/或计算出胃液体积>1.25 mL/kg所定义的“高危胃”的患病率。
计划进行择期手术的儿童连续纳入这项前瞻性队列研究。在仰卧位和右侧卧位均对胃窦进行术前超声检查。使用0 - 2级定性分级量表评估胃液含量。还在仰卧位和右侧卧位测量胃窦横截面积，以便根据先前描述的公式计算胃液体积。
我们分析了200名择期手术儿童。液体禁食的中位时间为4小时，固体禁食的中位时间>13小时。本研究纳入的儿童均无固体成分的证据。6名（3%）儿童胃窦为2级（仰卧位和右侧卧位均可见液体成分）。2名儿童胃液体积>1.25 mL/kg。“高危胃”的患病率为1%（95%置信区间：0.2% - 3.9%）。
根据我们的结果，只有1%的择期手术儿童有潜在的肺误吸风险增加。应进行进一步研究，以确定在全身麻醉前应进行胃内容物超声评估的择期手术儿童目标人群。
