Godschalx Vincent, Vanhoof Marc, Soetens Filiep, Van de Putte Peter, Hadzic Admir, Van de Velde Marc, Van Herreweghe Imré
From the Department of Anaesthesiology, UZ Leuven, Leuven, Belgium (VG), Department of Anaesthesiology, AZ Turnhout, Turnhout, Belgium (MV, FS), Department of Anaesthesiology, Imeldaziekenhuis, Bonheiden, Belgium (PVDP), Department of Anaesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium (AH, IVH), Department of Anesthesiology & Algology, Faculty of Medicine, KULeuven, Leuven, Belgium (AH), Department Cardiovascular Sciences, KU Leuven, Department of Anaesthesiology, UZ Leuven, Leuven, Belgium (MVDV).
Eur J Anaesthesiol Intensive Care. 2023 Jun 26;2(4):e0027. doi: 10.1097/EA9.0000000000000027. eCollection 2023 Aug.
The timing and technique of anaesthesia are challenging in patients with a history of recent food intake. The presence of gastric contents increases the risk of aspiration, potentially resulting in acute lung injury, pneumonia, or death. Delayed gastric emptying complicates the estimation of aspiration risk. Surprisingly, there are no fasting guidelines for emergency surgery. Point-of-care gastric ultrasound is a time-efficient, cost-efficient and accurate bedside tool with which to estimate residual gastric content and to guide decision-making in airway management and timing of general anaesthesia. This review summarises the prevailing concepts of ultrasound-guided gastric content assessment for emergency surgery.
Medline and Embase databases were searched for studies using ultrasound for the evaluation of gastric content in adults scheduled for emergency surgery.
Five prospective observational studies representing 793 emergency surgery patients showed that the incidence of 'full stomach' was between 18 and 56% at the time of induction. Risk factors for a full stomach before emergency surgery were abdominal or gynaecological/obstetric surgery, high body mass index and morphine consumption. No correlation between preoperative fasting time and the presence of a full/empty stomach was found. No deaths due to aspiration were reported.
The preoperative presence of gastric content before emergency surgery is high and the estimates used for clinical management are unreliable. This review demonstrates that gastric ultrasound is a valuable tool for evaluating gastric content. A flow chart for medical decision-making using gastric ultrasound before emergency surgery was developed to assist in clinical decision-making. The validity and practical applicability should be assessed in future studies.
对于近期有进食史的患者，麻醉的时机和技术颇具挑战性。胃内容物的存在会增加误吸风险，可能导致急性肺损伤、肺炎或死亡。胃排空延迟使误吸风险评估变得复杂。令人惊讶的是，目前尚无针对急诊手术的禁食指南。床旁胃超声是一种高效、经济且准确的床旁工具，可用于评估胃内残余物，并指导气道管理和全身麻醉时机的决策。本综述总结了急诊手术中超声引导下胃内容物评估的主流概念。
检索Medline和Embase数据库，查找使用超声评估计划进行急诊手术的成年患者胃内容物的研究。
五项前瞻性观察性研究共纳入793例急诊手术患者，结果显示诱导时“饱胃”的发生率在18%至56%之间。急诊手术前饱胃的危险因素包括腹部或妇科/产科手术、高体重指数和使用吗啡。未发现术前禁食时间与胃饱/空状态之间存在相关性。未报告因误吸导致的死亡病例。
急诊手术前胃内存在内容物的比例较高，目前用于临床管理的评估方法不可靠。本综述表明，胃超声是评估胃内容物的有价值工具。制定了急诊手术前使用胃超声进行医疗决策的流程图，以协助临床决策。其有效性和实际适用性有待未来研究评估。
