Ultrasound assessment of the gastric contents for the guidance of the anaesthetic strategy in infants with hypertrophic pyloric stenosis: a prospective cohort study

Gagey, Anne-Charlotte; Siqueira, Mathilde De Queiroz; Desgranges, François-Pierrick; Combet, Sylvie; Naulin, C; Chassard, D.; Bouvet, Lionel

doi:10.1093/bja/aew070

Cited by 50 publications

(48 citation statements)

References 29 publications

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“…In contrast, based on ultrasound findings, clinicians in this study proceeded with nonrapid induction or additional suctioning, and rapid induction was only performed in patients where imaging could not be obtained, or the stomach not fully emptied. There were no cases of pulmonary aspiration in this small cohort . In a follow‐up prospective cohort study of 143 children undergoing urgent surgery, gastric ultrasound obtained adequate images in 130 (90%) patients and resulted in a change in planned induction technique in 67 (47%) of patients.…”

Section: Oxygen Deliverymentioning

confidence: 79%

Emerging trends, techniques, and equipment for airway management in pediatric patients

Stein

Park

Kovatsis

2020

Pediatric Anesthesia

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Pediatric patients present unique anatomic and physiologic considerations in airway management, which impose significant physiologic limits on safe apnea time before the onset of hypoxemia and subsequent bradycardia. These issues are even more pronounced for the pediatric difficult airway. In the last decade, the development of pediatric sized supraglottic airways specifically designed for intubation, as well as advances in imaging technology such that current pediatric airway equipment now finally rival those for the adult population, has significantly expanded the pediatric anesthesiologist's tool kit for pediatric airway management. Equally important, techniques are increasingly implemented that maintain oxygen delivery to the lungs, safely extending the time available for pediatric airway management. This review will focus on emerging trends and techniques using existing tools to safely handle the pediatric airway including videolaryngoscopy, combination techniques for intubation, techniques for maintaining oxygenation during intubation, airway management in patients at risk for aspiration, and considerations in cannot intubate cannot oxygenate scenarios.

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Section: Oxygen Deliverymentioning

confidence: 79%

Emerging trends, techniques, and equipment for airway management in pediatric patients

Stein

Park

Kovatsis

2020

Pediatric Anesthesia

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“…We did not find any significant difference between the pre‐induction period and the immediate postoperative period preceding tracheal extubation regarding the qualitative assessment of gastric contents and in the antral CSA measured in the right lateral decubitus position in children undergoing ENT surgery. The antral CSA measured in the right lateral decubitus position is the main predictor of gastric fluid volume according to several mathematical models described in the paediatric population . In the present study, we used the formula described by Spencer et al to calculate the gastric fluid volume because the range of ages in our study population was close to the range of ages of the children studied when validating this formula.…”

Section: Discussionmentioning

confidence: 97%

“…In the present study, we used the formula described by Spencer et al to calculate the gastric fluid volume because the range of ages in our study population was close to the range of ages of the children studied when validating this formula. The other published models for the determination of gastric volume in paediatrics have been described in older children (6–14 years of age) or in infants .…”

Section: Discussionmentioning

confidence: 99%

“…Each ultrasound examination was performed with the child placed first in the supine and then in the right lateral decubitus position . The gastric antrum was scanned in a standardised sagittal plane in the epigastrium, including the left lobe of the liver and either the aorta or the inferior vena cava, as previously described . The maximal anteroposterior diameter (D1) and longitudinal diameter (D2) of the antrum were measured from serosa to serosa, in the right lateral decubitus position, allowing calculation of the antral cross‐sectional area (CSA) according to the following formula: antral CSA = (π × D1 × D2)/4 .…”

Section: Methodsmentioning

confidence: 99%

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Ultrasound assessment of gastric contents in children undergoing elective ear, nose and throat surgery: a prospective cohort study

Desgranges

Aubergy

et al. 2017

Anaesthesia

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Ultrasound examination of the gastric antrum allows reliable assessment of gastric contents and volume. Postoperative assessment of gastric contents before recovery from anaesthesia could help the physician to choose the most appropriate extubation technique after surgery in children. In this prospective observational study, we assessed whether significant changes occurred in gastric contents during the intra-operative period in children undergoing elective ear, nose and throat (ENT) surgery. Children aged between six months and 16 years were recruited consecutively. Ultrasound examination of the antrum was performed before induction of anaesthesia and at the end of surgery before tracheal extubation, and included quantitative and qualitative assessment of gastric contents. The mean (SD) gastric volume was 0.28 (0.30) ml.kg before surgery and 0.27 (0.30) ml.kg after surgery, p = 0.82. No solid contents were identified in the antrum, and the gastric volume was < 1.5 ml.kg in all patients during both ultrasound examinations. Our results suggest that, after elective ENT surgery, children are not at risk of a full stomach before tracheal extubation, and that pulmonary aspiration of blood that may occur after elective ENT surgery is probably not related to regurgitation of ingested blood from the stomach.

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“…24,48,49 For optimal imaging of children less than 40 kg, a linear high-frequency transducer is recommended (Fig. 10), whereas a low-frequency large curvilinear transducer is typically required for children weighing more than 40 kg.…”

Section: Evaluation Of the Pediatric Patientmentioning

confidence: 99%

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist

Haskins

Kruisselbrink

Boublik

et al. 2018

Regional Anesthesia and Pain Medicine

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This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set. Gastric US can provide valuable insight into the nature and volume of gastric content before performing a block with sedation or inducing anesthesia for an urgent or emergent procedure where NPO status is unknown. Patients with comorbidities that delay gastric emptying, such as diabetic gastroparesis, neuromuscular disorders, morbid obesity, and advanced hepatic or renal disease, may potentially benefit from additional assessment via gastric US before an elective procedure. Although gastric US should not replace strict adherence to current fasting guidelines or be used routinely in situations when clinical risk is clearly high or low, it can be a useful tool to guide clinical decision making when there is uncertainty about gastric contents.In this review, we will cover the relevant scanning technique and the desired views for gastric US. We provide a methodology for interpretation of findings and for guiding medical management for adult patients. We also summarize the current literature on specific patient populations including obstetrics, pediatrics, and severely obese subjects.

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Ultrasound assessment of the gastric contents for the guidance of the anaesthetic strategy in infants with hypertrophic pyloric stenosis: a prospective cohort study

Abstract: Our results suggest that the qualitative ultrasound assessment of the antral content may be a simple and useful point-of-care tool, for the choice of the most appropriate anaesthetic technique for pyloromyotomy according to the estimated risk of pulmonary aspiration of gastric contents.

Cited by 50 publications

References 29 publications

Emerging trends, techniques, and equipment for airway management in pediatric patients

Emerging trends, techniques, and equipment for airway management in pediatric patients

Ultrasound assessment of gastric contents in children undergoing elective ear, nose and throat surgery: a prospective cohort study

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist

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