Application of Gastric Antrum Ultrasound in Assessing the Aspiration Risk during Pediatric Emergency Surgery

Weilian WANG; Jie GONG; Jinliang XIAO; Chang ZHANG; Shengping LI

doi:10.12259/j.issn.2095-610X.S20231122

Volume 44 Issue 11

Nov. 2023

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Weilian WANG, Jie GONG, Jinliang XIAO, Chang ZHANG, Shengping LI. Application of Gastric Antrum Ultrasound in Assessing the Aspiration Risk during Pediatric Emergency Surgery[J]. Journal of Kunming Medical University, 2023, 44(11): 145-151. doi: 10.12259/j.issn.2095-610X.S20231122

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Application of Gastric Antrum Ultrasound in Assessing the Aspiration Risk during Pediatric Emergency Surgery

doi: 10.12259/j.issn.2095-610X.S20231122

1.
Dept. of Anesthesiology
2.
Dept. of Pain Treatment，Jingzhou Central Hospital，Jingzhou Hospital Affiliated to Yangtze University，Jingzhou Hubei 434020，China

Received Date: 2023-08-19
Available Online: 2023-11-09
Publish Date: 2023-11-30

Abstract

Abstract

Objective To investigate the application of point-of-care gastric antrum ultrasonography in the risk assessment of aspiration in children undergoing emergency surgery. Methods A total of 120 cases of pediatric emergency surgery in Jingzhou Central Hospital of Hubei Province from December 2020 to December 2021, aged 1-12 years, American Society of Anesthesiologists physical status I-III, scheduled for surgical treatment, were selected. First, according to whether it met the fasting guidelines issued by the American Society of Anesthesiologists in 2017, the clinical gastric emptying of the children were evaluated. The children were divided into clinical fasting group（CE group） and clinical full group（CF group）, and then Mindray M7 ultrasound was used to qualitatively and quantitatively evaluate the gastric contents in the gastric antrum. The children were divided into ultrasound empty group（UE group） and ultrasound full group（UF group）, and the consistency of clinical and ultrasound evaluation methods was recorded. The cross-sectional area（CSA） of the gastric antrum was measured before and after gastric tube suction in children in the right lateral position. The changes of CSA before and after gastric tube suction, the type and amount of food eaten before surgery, and the time interval between eating and ultrasound examination were recorded. Results A total of 108 children were finally included for statistical analysis. The consistency between clinical and ultrasound examination was poor, 92 cases（85.2%） were judged as fasting by both ultrasound and clinical. 4 cases（3.7%） were judged as fasting by ultrasound but full stomach by clinical examination. 9 cases（8.3%） were judged as full stomach by ultrasound but fasting by clinical examination. 3 cases（2.8%） were judged as full stomach by both ultrasound and clinical, （kappa=0.255, P=0.006）. There was a well correlation between food intake and CSA in gastric antrum before gastric tube aspiration（r =0.840, P<0.05）. Before aspiration, the gastric antrum CSA in the UF group was significantly larger than the UE group（P<0.05）; After suction, there was no significant difference in gastric antrum CSA between the two groups（P=0.324）. The UF group consumed more formula milk and high-fat food, the amount of food suctioned by the gastric tube and the food intake were more than UE group（P<0.05）, The ultrasound interval time in the UF group was shorter than the UE group（P<0.05）. The incidence of vomiting in the two groups was 8.3% and 5.2% respectively, and there was no significant difference between the two groups（P=0.674）. Conclusion Preoperative gastric antral ultrasonography combined with the type and amount of food intake in children undergoing emergency surgery can effectively help anesthesiologists to make an appropriate judgment of whether the stomach is full under emergency circumstances, so as to adjust the anesthesia strategy in time and choose the appropriate airway management.
- Gastric ultrasonography,
- Pediatric emergency surgery,
- Aspiration,
- Fasting

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References

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