Demirel Asiye, Özgünay Şeyda Efsun, Eminoğlu Şermin, Balkaya Ayşe Neslihan, Onur Tuğba, Kılıçarslan Nermin, Gamlı Mehmet
Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16310, Turkey.
Children (Basel). 2023 Aug 23;10(9):1432. doi: 10.3390/children10091432.
Anesthesia-related complications, such as pulmonary aspiration of gastric contents, occur in approximately 0.02-0.1% of elective pediatric surgeries. Aspiration risk can be reliably assessed by ultrasound examination of the gastric antrum, making it an essential non-invasive bedside tool. In this prospective observational study, since most of our patients are immigrants and have communication problems, we wanted to investigate gastric contents and the occurrence of "high risk stomach" in children undergoing elective surgery for the possibility of pulmonary aspiration, even if the children and/or parents reported their last oral intake time. This risk is defined by ultrasound findings of solid content in the antrum and/or a calculated gastric volume exceeding 1.25 mL/kg. Children aged 2-18 were included in the study. Both supine and right lateral decubitus (RLD) ultrasound examinations were performed on the antrum before surgery. Using a qualitative grading scale from 0 to 2, we evaluated the gastric fluid content. The cross-sectional area (CSA) of the antrum was measured in the RLD position, aiding the calculation of the gastric fluid volume according to an established formula by Perlas. Ultrasound measurements of 97 children were evaluated. The median fasting duration was 4 h for liquids and 9 h for thick liquids and solids. Solid content was absent in all the children. Five children (5.2%) exhibited a grade 2 antrum, implying that fluid content was visible in both the supine and RLD positions. The median antral CSA in the RLD was 2.36 cm, with a median gastric volume of 0.46 mL/kg. For patients with a grade 0 antrum, a moderate and positive correlation was observed between the antral CSA and BMI, and a strong and positive correlation was evident between the antral CSA and age, similar to a grade 1 antrum. Only a single child (1%) had a potentially elevated risk of aspiration of gastric contents. Hence, the occurrence of a "high risk stomach" was 1% (95% confidence interval: 0.1-4.7%) and is consistent with the literature. As a necessary precaution, we propose the regular use of ultrasound evaluations of gastric contents, given their non-invasive, bedside-friendly, and straightforward implementation, for identifying risks when fasting times are uncertain and for ruling out unknown risk factors in each potential patient.
麻醉相关并发症，如胃内容物的肺误吸，在约0.02 - 0.1%的择期小儿手术中发生。通过超声检查胃窦可可靠地评估误吸风险，这使其成为一种重要的非侵入性床边工具。在这项前瞻性观察研究中，由于我们的大多数患者是移民且存在沟通问题，我们想调查择期手术儿童的胃内容物及“高危胃”的发生情况，以评估肺误吸的可能性，即便儿童和/或家长报告了他们上次的口服摄入时间。这种风险由胃窦内实性内容物的超声检查结果和/或计算出的胃容量超过1.25 mL/kg来定义。2至18岁的儿童被纳入研究。术前对胃窦进行仰卧位和右侧卧位（RLD）超声检查。我们使用从0到2的定性分级量表评估胃液含量。在RLD位测量胃窦的横截面积（CSA），根据Perlas建立的公式辅助计算胃液量。对97名儿童的超声测量结果进行了评估。液体的中位禁食时间为4小时，浓稠液体和固体的中位禁食时间为9小时。所有儿童均无实性内容物。5名儿童（5.2%）胃窦显示为2级，这意味着在仰卧位和RLD位均可见液体内容物。RLD位胃窦的中位CSA为2.36 cm，中位胃容量为0.46 mL/kg。对于胃窦为0级的患者，胃窦CSA与BMI之间观察到中度正相关，胃窦CSA与年龄之间存在强正相关，1级胃窦情况类似。只有一名儿童（1%）有胃内容物误吸的潜在风险升高。因此，“高危胃”的发生率为1%（95%置信区间：0.1 - 4.7%），与文献一致。作为必要的预防措施，鉴于超声评估胃内容物具有非侵入性、床边操作方便且实施简单的特点，我们建议在禁食时间不确定时定期使用超声评估胃内容物，以识别风险并排除每个潜在患者中的未知风险因素。
