Ultrasound assessment of gastric content in fasted patients before elective laparoscopic cholecystectomy: a prospective observational single-cohort study

Abstract

Background Patients with symptomatic gallbladder diseases exhibit delayed gastric emptying. We evaluated the residual gastric content in fasted patients scheduled for elective laparoscopic cholecystectomy because of symptomatic gallbladder disease using ultrasonography. Methods This prospective observational single-cohort study was approved by the Institutional Review Board, and written informed consent was obtained from all included patients. Before anesthesia induction, the gastric antrum was examined by ultrasound. Once the presence of solid content was excluded, the patients were classified using a three-point grading system (grade 0: no fluid; grade 1: fluid in the right lateral decubitus position; grade 2: fluid in both the supine and right lateral decubitus positions), and the fluid volume was measured. A stomach was considered empty if it had no contents or B 1.5 mLÁkg -1 of fluid, and was considered full if solid content or [ 1.5 mLÁkg -1 of fluid was detected. Results Among 138 patients, 18 patients (13%) presented with a full stomach, 12 (9%) of whom had solid content, and six (4%) of whom had [1.5 mLÁkg -1 of fluid in their stomach. Among the remaining 120 patients with an empty stomach, 65 patients presented with a grade 0 antrum, and 55 patients with a grade 1 or 2 antrum with B 1.5 mLÁkg -1 of fluid. Conclusion The gastric ultrasound assessment revealed that 13% of patients scheduled for elective cholecystectomy because of symptomatic gallbladder disease had a full stomach despite following the fasting guidelines. This was higher than the reported incidence of a full stomach among the general surgical population. Further studies are required to delineate the clinical implications of our findings. Trial registration www.ClinicalTrials.gov (NCT03259841); registered 4 August, 2017. RésuméContexte Les patients atteints de maladies vésiculaires symptomatiques souffrent de retard de la vidange gastrique. Nous avons évalué par échographie le contenu gastrique résiduel chez des patients à jeun devant subir une cholécystectomie non urgente par laparoscopie en raison de maladie vésiculaire symptomatique.

Ultrasound assessment of residual gastric volume in older adults undergoing staged-bilateral total knee arthroplasty after consuming carbohydrate-containing fluids: a prospective observational study

“…One notable aspect of this study was that residual GV > 1.5 ml/kg was observed in six patients before the second TKA operation that fortunately did not manifest as pulmonary aspiration. Although the strict threshold of GV that increases the risk of pulmonary aspiration is controversial, recent reports have announced that patients with GV > 1.5 ml/kg are a high-risk group for pulmonary aspiration [ 13 , 14 ], and residual GV > 1.5 ml/kg was occasionally observed in fasted patients suggesting incomplete gastric emptying [ 5 , 17 ]. However, there was a report that no one had a residual GV > 1.5 ml/kg after 2 h of drinking carbohydrate-containing fluid in ambulatory surgery [ 18 ], and in our study, there was no patient with a residual GV > 1.5 ml/kg in the first TKA.…”

“…One study demonstrated that fasting time was not associated with residual gastric volume (GV), showing that the incidence of full stomach was 35% in patients who had unplanned surgery and fasted for at least 6 h [ 4 ]. Even in scheduled laparoscopic cholecystectomy, 13% of patients showed a full stomach despite adherence to the recommended fasting time [ 5 ].…”

Impact of preoperative carbohydrate loading on gastric volume in patients with type 2 diabetes

“…Patients with Perlas grade I had < 100 mL gastric content, whereas those with grade II had obvious gastric content in both supine and RLD positions[ 23 ]. Moreover, GV/W > 1.5 mL/kg helps determine the risk of reflux and aspiration[ 24 - 26 ]. In our study, the number of patients with Perlas grade II and GV/W > 1.5 mL/kg did not differ among the groups.…”

Effect of facemask oxygenation with and without positive pressure ventilation on gastric volume during anesthesia induction in patients undergoing laparoscopic cholecystectomy or partial hepatectomy: a randomized controlled trial

“…According to previous studies, 2.7-6.2% of fasting patients were defined as a sonographic full stomach state before elective surgery [17,18]. Furthermore, despite following the fasting guidelines, 13% of the patients planned for elective laparoscopic cholecystectomy for symptomatic gallbladder disease appeared as a full stomach, determined by ultrasound imaging, before the anesthesia induction [19]. Continuous positive airway pressure using a facemask can result in gastric insufflation.…”