Gal Oren, Rotshtein Mark, Feldman Dan, Mari Amir, Hallak Motti, Kopelman Yael
Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel.
Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Clin Med Insights Womens Health. 2019 Mar 14;12:1179562X19828372. doi: 10.1177/1179562X19828372. eCollection 2019.
Traditionally, intubation of pregnant women has been performed using a rapid sequence induction. This is due to the classical concept that women with more than 18 weeks of pregnancy (mid-second trimester) are always considered to have an increased risk of aspiration due to a number of factors, regardless of the fasting duration. Rapid sequence induction is associated with a higher rate of adverse events.
Our study aimed to illuminate the hypothesis that there is no difference in gastric volume between term-pregnant women and non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Accordingly, we measured gastric volume and content before anesthesia in term-pregnant women undergoing elective cesarean section, and to compare it with non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures.
In this single-center prospective study, the gastric volume and content were assessed by abdominal ultrasound (AUS) just prior to the scheduled procedure. AUS was performed in the sagittal or para-sagittal plain in the upright position and the stomach content was estimated according to the antral circumferential area. Group 1 consisted of 50 term-pregnant women scheduled for cesarean section. Group 2 consisted of 45 non-pregnant or first-trimester pregnant women who were scheduled for minor gynecologic procedure.
Despite significant longer fasting time prior to the interventional procedure in the non-pregnant or first-trimester women group, there was no significant difference in gastric volume between term-pregnant and first-trimester pregnant women (3.2 ± 0.97 cm vs 3.2 ± 0.79 cm; = .97). Gastric volume was small in the two groups.
Fasting gastric volume before cesarean section in term-pregnant women is small and is not different than in non-pregnant or first-trimester women undergoing minor gynecologic procedures. Ultrasound estimation of gastric volume is a reliable and easy-to-perform technique which might help in decision-making regarding the airway management prior to induction of anesthesia in pregnant women.
传统上，孕妇插管采用快速顺序诱导法。这是因为经典观念认为，怀孕超过18周（孕中期）的女性由于多种因素，无论禁食时间长短，总是被认为有误吸风险增加的情况。快速顺序诱导法与较高的不良事件发生率相关。
我们的研究旨在阐明这一假设，即足月孕妇与接受小型妇科手术的非孕妇或孕早期孕妇的胃容量没有差异。因此，我们测量了择期剖宫产足月孕妇麻醉前的胃容量和内容物，并将其与接受小型妇科手术的非孕妇或孕早期孕妇进行比较。
在这项单中心前瞻性研究中，在预定手术前通过腹部超声（AUS）评估胃容量和内容物。在直立位的矢状面或旁矢状面进行AUS，并根据胃窦圆周面积估计胃内容物。第1组由50名计划剖宫产的足月孕妇组成。第2组由45名计划进行小型妇科手术的非孕妇或孕早期孕妇组成。
尽管非孕妇或孕早期孕妇组在介入手术前的禁食时间明显更长，但足月孕妇与孕早期孕妇的胃容量没有显著差异（3.2±0.97厘米对3.2±0.79厘米；P = 0.9）。两组的胃容量都很小。
足月孕妇剖宫产术前的空腹胃容量很小，与接受小型妇科手术的非孕妇或孕早期孕妇没有差异。超声估计胃容量是一种可靠且易于操作的技术，可能有助于在孕妇麻醉诱导前进行气道管理的决策。
