Key result
Gastric ultrasound demonstrated that gastric content is present in 18 to 56% of emergency surgery patients undergoing anaesthesia, with no correlation found between fasting times and stomach content.
Why the study?
There are no fasting guidelines for emergency surgery, and delayed gastric emptying complicates aspiration risk estimation.
Does point-of-care gastric ultrasound accurately assess gastric content in adults scheduled for emergency surgery?
Does point-of-care gastric ultrasound accurately assess gastric content in adults scheduled for emergency surgery?
Point-of-care gastric ultrasound is a valuable tool for evaluating gastric content before emergency surgery, as clinical estimates based on fasting time are unreliable.
May aid aspiration risk assessment in emergency surgery without fasting guidelines; leaves open impact on outcomes before routine adoption.
BACKGROUND: 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. METHODS: Medline and Embase databases were searched for studies using ultrasound for the evaluation of gastric content in adults scheduled for emergency surgery. RESULTS: 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. CONCLUSION: 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.
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Godschalx et al. (2023) conducted a review in Emergency surgery (n=793). Gastric ultrasound was evaluated on Incidence of 'full stomach' at the time of induction. Gastric ultrasound demonstrated that gastric content is present in 18 to 56% of emergency surgery patients undergoing anaesthesia, with no correlation found between fasting times and stomach content.
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