Ultrasonographic evaluation of gastric content during labour under epidural analgesia: a prospective cohort study

Bataille, Aurélien; Rousset, Julien; Marret, Emmanuel; Bonnet, Francis

doi:10.1093/bja/aet435

Cited by 65 publications

(51 citation statements)

References 15 publications

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“…40 Several authors have studied quantitative gastric US in the obstetric population. 33,34,[43][44][45] Most have focused on defining cutoff values for the gastric antral area that would allow rapid differentiation between varying levels of aspiration risk. For instance, Jay et al 44 reported that using Bouvet's model, a gastric antral area of less than 381 mm 2 in the supine position is 81% sensitive and 76% specific to identify a grade 0 antrum.…”

Section: Evaluation Of the Obstetric 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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Section: Evaluation Of the Obstetric 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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“…52,53) Several mathematical models have been used to assess different patient positions and clinical scenarios. [54][55][56][57] A study by Bouvet 44) used the antral cross-sectional area with cut-off values measured in a 45° semi-recumbent position. CSAs > 3.4 cm 2 and > 3.8 cm 2 were reported in non-pregnant and pregnant patients, respectively, and these values correlated with a gastric volume > 0.8 ml kg − 1 .…”

Section: Gastric Contents and Gastric Emptyingmentioning

confidence: 99%

“…Bataille et al 54) determined the cut-off value corresponding to increased gastric content by ultrasound measurement of antral CSA in non-laboring women in their third trimester. Ultrasound was performed before and after the intake of a non-clear fluid, followed by two antral CSA measurements on parturients who were in spontaneous labor during catheter placement for epidural analgesia and at full cervical dilatation.…”

Section: Gastric Contents and Gastric Emptyingmentioning

confidence: 99%

The use of lumbar spine and gastric ultrasound in perioperative obstetric anesthesia

Ohashi

Farzi

Siddiqui

2018

Hypertens Res Pregnancy

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Neuraxial anesthesia is a gold standard anesthetic technique employed for labor analgesia and cesarean section. Spinal cord injury can occur if the needle insertion is performed above the recommended lumbar spine level. Pre-procedural lumbar spine ultrasound scanning can provide several benefits, such as increasing first attempt success rate, reducing the number of attempts, and reducing redirection of the needle. Pulmonary aspiration during general anesthesia is a fatal complication which remains a cause of maternal mortality. Gastric content volume (GCV) is an important component related to the risk of regurgitation followed by aspiration. There is growing interest in the utility of bedside gastric ultrasound to assess GCV in non-obstetric and obstetric populations.

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“…Administration can be initiated the evening before surgery in elective cases. Recent studies have suggested that the use of bedside gastric ultrasonography can be useful in assessing gastric contents during labor49 and prior to elective cesarean delivery 50…”

Section: Technical Considerationsmentioning

confidence: 99%

Managing anesthesia  for cesarean section in obese patients: current perspectives

Lamon¹,

Habib²

2016

LRA

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Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients.

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Ultrasonographic evaluation of gastric content during labour under epidural analgesia: a prospective cohort study

Cited by 65 publications

References 15 publications

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist

The use of lumbar spine and gastric ultrasound in perioperative obstetric anesthesia

Managing anesthesia  for cesarean section in obese patients: current perspectives

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Ultrasonographic evaluation of gastric content during labour under epidural analgesia: a prospective cohort study

Cited by 65 publications

References 15 publications

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist

The use of lumbar spine and gastric ultrasound in perioperative obstetric anesthesia

Managing anesthesia &nbsp;for cesarean section in obese patients: current perspectives

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Managing anesthesia for cesarean section in obese patients: current perspectives