Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2019.04.002
Brazilian Journal of Anesthesiology
Scientific Article

Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section

Ultrassom de antro gástrico em gestantes a termo antes de cesariana eletiva

Caio Klippel Amaral; Márcio Luiz Benevides; Marília Marquioreto Benevides; Diogo Leite Sampaio; Cor Jesus Fernandes Fontes

http://dx.doi.org/10.1016/j.bjane.2019.04.002 Braz J Anesthesiol, vol.69, n3, p.266-271, 2019
PDF English
PDF Português
Downloads: 0
Views: 1029

Abstract

Abstract Background and objectives: Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. Method: In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. Results: The median (IIQ) for gastric antral cross-sectional area was 4 cm2 (2.8-6.3), for the estimated gastric volume it was 49.8 mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62 mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3 cm2 (95% CI: 7.6-15.6) and 1.42 mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p < 0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p < 0.01 and p < 0.02. Conclusion: Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.

Keywords

Ultrasound, Gastric antrum, Pregnant women, Cesarean section, Aspiration pneumonia

Resumo

Resumo Justificativa e objetivos: As gestantes são consideradas pacientes de risco para aspiração pulmonar do conteúdo gástrico. O objetivo foi avaliar a área transversal do antro gástrico por meio de ultrassonografia. Método: Neste estudo prospectivo, 85 gestantes a termo agendadas foram submetidas à ultrassonografia do antro gástrico. Os desfechos foram a mensuração da área transversal do antro gástrico (desfecho principal), a estimativa do volume gástrico, a incidência de gestantes sob risco de aspiração pulmonar, a associação entre a área transversal do antro gástrico e características clínico-demográficas. A área transversal do antro gástrico e do volume gástrico foi comparada de acordo com o índice de massa corporal < 30 ou ≥ 30. Resultados: A mediana (IIQ) da área transversal do antro gástrico foi 4 cm2 (2,8-6,3), do volume gástrico estimado 49,8 mL (33,7-87,2) e do volume gástrico estimado em mL.kg-1 de 0,62 mL.kg-1 (0,39-0,95). O percentil 95 [intervalo de confiança (IC) 95%] da área transversal do antro gástrico e do volume gástrico estimado foi ≤ 10,3 cm2 (IC 95%: 7,6-15,6) e 1,42 mL.kg-1 (IC 95%: 1,20-2,64), respectivamente. A incidência de gestantes sob risco de aspiração pulmonar foi de 3,5% (IC: 3,5 (1,2-9,8). Houve correlação positiva entre a área transversal do antro gástrico e peso, p < 0,001 e índice de massa corporal p < 0,001. As pacientes com índice de massa corporal ≥ 30 apresentaram maior área transversal do antro gástrico, e do volume gástrico estimado, do que as com índice de massa corporal < 30, respectivamente p < 0,01 e p < 0,02. Conclusão: A mensuração da área transversal do antro gástrico de gestantes é factível e fácil. A área transversal do antro gástrico correlacionou-se positivamente com peso e índice de massa corporal. A estimativa do volume gástrico através da mensuração da área transversal do antro gástrico pode identificar pacientes sob risco de aspiração pulmonar. As pacientes obesas apresentaram área transversal do antro gástrico e volume gástrico estimado maior do que as não obesas.

Palavras-chave

Ultrassonografia, Antro gástrico, Gestante, Cesariana, Pneumonia aspirativa

References

Cook TM, Woodall N, Frerk C. Fourth National Audit Project Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106:617-31.

Costantine MM. Physiologic and pharmacokinetic changes in pregnancy. Front Pharmacol. 2014;3:65.

Zieleskiewicz L, Bellefleur JP, Leone M. Upper airway management in obstetrics: results of a French survey. Can J Anaesth. 2009;56:265-6.

Kinsella SM, Winton AL, Mushambi MC. Failed tracheal intubation during obstetric general anaesthesia: a literature review. Int J Obstet Anesth. 2015;24:356-74.

Chassard D. Maternal deaths due to anesthesia complications. Results from the French confidential enquiry into maternal deaths, 2010-2012. Gynecol Obstet Fertil Senol. 2017;45(S12):S54-7.

Naslund E, Bogefors J, Gryback H. Gastric emptying: comparison of scintigraphic, polyethylene glycol dilution and paracetamol tracer techniques. Scand J Gastroenterol. 2000;35:375-9.

Hamada SR, Garcon P, Ronot M. Ultrasound assessment of gastric volume in critically ill patients. Intensive Care Med. 2014;40:965-72.

Hoad CL, Parker H, Hudders N. Measurement of gastric meal and secretion volumes using magnetic resonance imaging. Phys Med Biol. 2015;60:1367-83.

Perlas A, Chan VWS, Lupu CM. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009;111:82-9.

Bouvet L, Mazoit JX, Chassard D. Clinical assessment of ultrasonographic measuremnt of antral estimating preoperative gastric content and volume. Anesthesiology. 2011;114:1086-92.

Perlas A, Mitsakakis N, Liu L. Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesth Analg. 2013;116:357-63.

Kruisselbrink R, Arzola C, Jackson T. Ultrasound assessment of gastric volume in severely obese individuals: a validation study. Br J Anaesthesia. 2017;118:77-82.

Song IK, Kim HJ, Lee JH. Ultrasound assessment of gastric volume in children after drinking carbohydrate-containing fluids. Br J Anaesth. 2016;116:513-7.

Batalille A, Rousset J, Marret E. Ultrasonographic evaluation of gastric content during labour under epidural analgesia: a prospective cohort study. Br J Anaesth. 2014;112:703-7.

Zieleskiewicz L, Boghossian MCA, Delmas C. Ultrasonographic measurement of antral area for estimating gastric fluid volume in parturients. Br J Anaesth. 2016;117:198-205.

Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113:12-22.

Perlas A, Van de Putte P, Van Houwe P. I-AIM framework for point-of-care gastric ultrasound. Br J Anaesth. 2016;116:7-11.

Arzola C, Perlas A, Siddiqui NT. Bedside gastric ultrasonography in term pregnant women before eletive cesarean delivery: a prospective cohort study. Anesth Analg. 2015;121:752-8.

Zieleskiewicz L, Bouvet L, Einav S. Diagnostic point-of-care ultrasound: applications in obstetric anaesthetic management. Anaesthesia. 2018;73:1265-79.

Wong CA, Loffredi M, Ganchiff JN. Gastric emptying of water in term pregnancy. Anesthesiology. 2002;96:1395-400.

Jay L, Zieleskiewicz L, Desgranges FP. Determination of cut-off value of antral area measured in the supine position for the fast diagnosis of an empty stomach in the parturient. Eur J Anaesthesiol. 2017;34:150-7.

Barboni E, Mancinellli P, Bitossi U. Ultrasound evaluation of the stomach and gastric emptying in pregnant women at term: a case-control study. Minerva Anestesiol. 2016;82:543-9.

Hakak S, McCaul CL, Crowley L. Ultrasonographic evaluation of gastric contents in term pregnant women fasted for six hours. Int J Obstet Anesth. 2018;34:15-20.

Rouget C, Chassard D, Bonnard C. Changes in qualitative and quantitative ultrasound assessment of the gastric antrum before and after elective caesarean section in term pregnant women: a prospective cohort study. Anaesthesia. 2016;71:1284-90.

Obesity and overweight. .

Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124:270-300.

Wong CA, McCarthy RJ, Fitzgerald PC. Gastric emptying of water in obese pregnant women at term. Anesth Analg. 2007;105:751-5.

Arzola C, Perlas A, Siddiqui NT. Gastric ultrasound in the third trimester of pregnancy: a randomised controlled trial to develop a predictive model of volume assessment. Anaesthesia. 2018;73:295-303.

5dc568440e8825195a593254 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections