在择期手术的术前禁食不依从的儿科患者中使用即时床旁胃超声和麻醉管理：一项回顾性研究。
The use of point of care gastric ultrasound and anesthesia management in pediatric patients with preoperative fasting non-adherence scheduled for elective surgical procedures: a retrospective study.
机构信息
Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
University of Cincinnati College of Medicine, Cincinnati, OH, USA.
出版信息
BMC Anesthesiol. 2024 Jul 15;24(1):237. doi: 10.1186/s12871-024-02628-0.
BACKGROUND
Failure to adhere to perioperative fasting requirements increases aspiration risk and can lead to delay or cancellation of surgery. Point of care gastric ultrasound may guide decision-making to delay, cancel or proceed with surgery.
METHODS
This study aimed to describe gastric contents using point of care gastric ultrasound in pediatric patients with known fasting guideline violations presenting for elective surgery. This was a single-center retrospectivechart review of gastric ultrasound scans in patients presenting for elective surgeries with "nothing by mouth" violation (per fasting guidelines) or unclear fasting status. The primary outcome is description of gastric contents using point of care ultrasound. The ultrasound findings were classified as low-risk for aspiration (empty, clear fluid < 1.5 ml/kg), high-risk (solids, clear fluid > 1.5 ml/kg), or inconclusive study. Gastric ultrasound findings were communicated to the attending anesthesiologist. For patients proceeding without delay the estimated time saved was defined as the difference between ultrasound scan time and presumed case start time based on American Society of Anesthesiologists fasting guidelines.
RESULTS
We identified 106 patients with a median age of 4.8 years. There were 31 patients (29.2%) that had ultrasound finding of high-risk gastric contents. These patients had cases that were delayed, cancelled or proceeded with rapid sequence intubation. Sixty-six patients (62.3%) were determined to be low-risk gastric contents and proceeded with surgery without delay. For these patients, a median of 2.6 h was saved. No aspiration events were recorded for any patients.
CONCLUSIONS
It is feasible to use preoperative point of care gastric ultrasound to determine stomach contents and risk-stratify pediatric patients presenting for elective surgical procedures with fasting non-adherence. Preoperative gastric ultrasound may have a role in determining changes in anesthetic management in this patient population.
背景
未能遵守围手术期禁食要求会增加误吸风险，并可能导致手术延迟或取消。床边胃超声检查可指导决策，以延迟、取消或继续手术。
方法
本研究旨在描述已知禁食指南违规的择期手术患儿的床边胃超声检查中的胃内容物。这是一项单中心回顾性图表研究，纳入了因“禁食（按禁食指南）”或禁食状态不明确而违反禁食指南的择期手术患儿的胃超声检查。主要结局是使用床边超声检查描述胃内容物。超声检查结果分为低风险（空胃，< 1.5 ml/kg 清亮液体）、高风险（固体，> 1.5 ml/kg 清亮液体）或不确定研究。将胃超声检查结果传达给主治麻醉师。对于无延迟进行手术的患者，节省的估计时间定义为超声扫描时间与基于美国麻醉医师协会禁食指南的假定病例开始时间之间的差异。
结果
我们共纳入了 106 名中位年龄为 4.8 岁的患儿。31 名患儿（29.2%）的超声检查结果显示胃内容物为高风险。这些患儿的手术被延迟、取消或进行快速序贯插管。66 名患儿（62.3%）被确定为低风险胃内容物，无延迟进行手术。这些患者的中位节省时间为 2.6 小时。没有任何患者发生误吸事件。
结论
术前床边胃超声检查可用于确定胃内容物，并对禁食不依从的择期手术患儿进行风险分层。术前胃超声检查可能在确定该患者人群的麻醉管理变化方面具有作用。
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