Aspiration Of Gastric Contents Research Articles

Lung injury caused by aspiration of organophosphorus insecticide and gastric contents in pigs

Introduction Patients who require mechanical ventilation after self-poisoning with ingested organophosphorus (OP) insecticides often die. Aspiration of stomach contents may contribute to lung injury and lethality. This study was designed to assess the severity of direct and indirect pulmonary injury created by pulmonary instillation of mixtures of OP insecticide, solvent (Solv) and porcine gastric juice (GJ) compared to controls. Methods Terminally anaesthetised minipigs (groups n = 5) were exposed to sham bronchoscopy or given mixtures (0.5 mL/kg) of: saline, GJ, OP insecticide and GJ (OP + GJ), or Solv and GJ (Solv + GJ), placed into the right lung, and monitored for 48 h. Lung injury was assessed through analysis of bronchoalveolar lavage fluid (BALF), computed tomography and histopathology. Results OP + GJ created a direct lung injury consisting of neutrophil infiltration, oedema and haemorrhage, as well as indirect injury to the other lung. OP + GJ directly-injured lung parenchyma had increased concentrations of BALF protein, albumin, IL-6, IL-8 and C-reactive protein (CRP) at 24 h (p < 0.05), and BALF protein, albumin and CRP at 48 h (p < 0.05), when compared with controls. Aspiration of GJ produced similar direct effects to OP + GJ but less indirect lung injury. Lung injury was less severe after Solv + GJ, for combined lung histopathology scores (vs. OP + GJ, p < 0.05) and for the proportion of directly-injured lung that was poorly/non-aerated at 48 h. Conclusion Pulmonary instillation of OP + GJ created more lung damage than controls or Solv + GJ. In patients with severe OP insecticide poisoning and reduced consciousness, early airway protection is likely to reduce pulmonary damage.

Comparison of Preoperative Assessment of Gastric Volume and pH in Patients Undergoing Elective Surgery with Prior Two Hour Fasting versus Overnight FastingA Randomised Clinical Trial

Introduction: Aspiration of gastric content is a known lifethreatening, yet preventable complication of anaesthesia. While mostly all elective procedures do follow the preoperative fasting protocols as recommended by American Society of Anaesthesia (ASA), there are many situations where the fasting guideline cannot be followed considering the emergency. In such cases, bedside ultrasound assessment of gastric volume can become an important tool to stratify aspiration related risk. Aim: To find out the actual trends of gastric volume and pH in patients with two hour fasting with a prokinetic drug versus overnight fasting who are undergoing elective procedures. Materials and Methods: This single centre, randomised clinical trial was conducted in the Department of Anaesthesia at Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India, between December 2020 and July 2021, among 50 patients of ASA grade I undergoing elective procedures under general anaesthesia. Participants were divided into two groups. Group A patients were advised overnight fasting while group B participants were advised two hour fasting for clear liquids followed by intravenous (i.v.) metoclopramide injection. Assessment of gastric volume and other gastric parameters were done using a portable ultrasound machine. The pH of gastric content was measured using pH strips. Gastric content was obtained using Ryle’s Tube placed in the patient, postinduction of anaesthesia. Collected data was statistically analysed using Unpaired t-test for all qualitative data. Results: Significant difference in the anteroposterior diameter (3.46±0.34 in group A versus 2.24±0.30 in group B), cranio-caudal diameter (4.77±0.51 in group A versus 3.71±0.36 in group B), antral curved surface area (9.90±0.77 in group A versus7.77±1.04 in group B) and gastric volume (127.48±13.09 in group A versus 104.65±15.43 in group B) and pH (2.08±0.28 in group A versus 2.80±0.41 in group B) was observed (p-value=0.0001). However, no significant difference in any gastric parameter, mentioned above, was noted before and after injecting intravenous metoclopramide. Conclusion: Bedside ultrasound assessment of gastric volume is an important toolfor aspiration risk stratification especially in emergency, non-fasting patients.

Vascular hyperpermeable molecules potentially contributing to the development of pulmonary edema in sepsis-associated ARDS

The acute respiratory distress syndrome (ARDS) is an important cause of respiratory failure in critically ill patients and may become a life-threatening condition where inflammation of the lungs may begin in one lung but eventually affects both, leading to damage to the alveoli and surrounding small blood vessels. ARDS is particularly characterized by noncardiogenic pulmonary edema caused by an increase in pulmonary capillary permeability. Several clinical disorders can precipitate in ARDS, including pneumonia, sepsis, aspiration of gastric contents, and major trauma. The most common cause of ARDS is sepsis, which is a serious and widespread infection of the bloodstream and is now defined as life-threatening organ dysfunction due to a dysregulated reponse of the host to infection. In sepsis, a number of vascular hyperpermeable factors, such as histamine, nitric oxide, thromboxane A2, and vascular endothelial growth factor, can be overproducted and contribute to the development of pulmonary edema. Given that sepsis can be regarded as a gene-related disorder, the nucleic-acid based gene therapeutic strategy to regulate some transcription factors involved in expression of vascular hyperpermeable genes may be considered to be a promising novel approach for treatment of ARDS in sepsis.

Respiratory distress syndrome. Systematic review

Respiratory distress syndrome is a prevalent cause of morbidity and mortality, however, patients who survive have sequelae due to lung damage which reduces their quality of life. Objective: to examine the empirical evidence on respiratory distress syndrome. Methodology: A systematic review of articles was carried out in databases such as Pubmed, Scopus, Scielo, Liliacas, using the key words "Respiratory Distress Syndrome, Risk Factors". We searched for articles written in Spanish, published in the last 10 years. Results: the most prevalent factors for developing respiratory distress syndrome are pulmonary clinical causes such as pneumonia, aspiration of gastric contents and thoracic trauma, mechanical ventilation and extrapulmonary causes such as shock, sepsis, severe trauma, blood transfusions, among others, and genetic factors. Conclusion: acute respiratory distress syndrome (ARDS) is a life-threatening lung injury, most people with ARDS are already in the hospital due to trauma or disease.

Respiratory distress syndrome. Systematic review

Respiratory distress syndrome is a prevalent cause of morbidity and mortality, however, patients who survive have sequelae due to lung damage which reduces their quality of life. Objective: to examine the empirical evidence on respiratory distress syndrome. Methodology: A systematic review of articles was carried out in databases such as Pubmed, Scopus, Scielo, Liliacas, using the key words "Respiratory Distress Syndrome, Risk Factors". We searched for articles written in Spanish, published in the last 10 years. Results: the most prevalent factors for developing respiratory distress syndrome are pulmonary clinical causes such as pneumonia, aspiration of gastric contents and thoracic trauma, mechanical ventilation and extrapulmonary causes such as shock, sepsis, severe trauma, blood transfusions, among others, and genetic factors. Conclusion: acute respiratory distress syndrome (ARDS) is a life-threatening lung injury, most people with ARDS are already in the hospital due to trauma or disease.

Sudden death of apregnant woman because of massive aspiration-case report and review of literature.

Massive aspiration of gastric contents as acause of death in pregnancy without anesthesia is possible, but is not documented in the available literature as aseparate case report. To describe sudden death of a pregnant woman because of massive aspiration of gastric contents. The presence of avalvular anomaly in a26-year-old woman had been known since childhood: the prolapse of both mitral cusps. In the 34th week of her second pregnancy, after dinner, she went to take ashower when she collapsed with abundant vomiting of stomach contents. The ambulance came in 20 min and started aresuscitation procedure which was unsuccessful, and the death of the pregnant woman was established in the 34th week of pregnancy. Autopsy revealed massive aspiration of gastric contents into the trachea and bronchi, pulmonary edema, and generalized cyanosis. Left ventricular dilatation was found in the heart, with prolapse of both mitral valve cusps. Sudden deaths in pregnancy are rare and dramatic conditions in emergency medicine. Cardiac checkups are very important for pregnant women with heart failures or heart anomalies, and must be recommended by gynecologists.

Assessing gastric contents in children before general anesthesia for acute extremity fracture: An ultrasound observational cohort study

Study objectiveChildren with acute extremity fractures are commonly considered to be at risk of pulmonary aspiration of gastric contents during the induction of anesthesia. This study aimed to evaluate the proportion of such children with high-risk gastric contents using preoperative gastric ultrasound. DesignProspective observational cohort study. SettingSpecialist pediatric center over a 30-month period. PatientsChildren undergoing surgery within 24 h of an acute extremity fracture. InterventionsNone. MeasurementsAccording to preoperative qualitative and quantitative ultrasound analysis of the antrum in the supine and right lateral decubitus positions, gastric contents were classified as high-risk (clear liquid with calculated gastric fluid volume > 0.8 mL.kg−1, thick liquid, or solid) or low-risk. Factors associated with high-risk gastric contents were identified by multivariable analysis. Main resultsForty-one children (37%; 95% CI: 28–47) of the 110 studied (mean(SD) age: 10(3) years) presented with high-risk gastric contents, including 26 (24%; 95% CI: 16–33) with solids/thick liquid contents. Scanning in the supine position alone allowed a diagnosis of high-risk gastric contents in 23 children out of the 63 for whom right lateral decubitus positioning was unfeasible. Gastric contents remained undetermined in 41 children, including one with a non-contributory gastric US (antrum non-visualized). Proximal limb fractures (OR: 2.5; 95% CI: 1.0–6.2), preoperative administration of opioids (OR: 3.9; 95% CI: 1.1–13), and the absence of bowel sounds (OR: 8.0; 95% CI: 1.4–44) were associated with high-risk gastric contents. Performing surgery the day following the trauma was a protective factor (OR: 0.1; 95% CI: 0.0–0.6). No cases of pulmonary aspiration occurred. ConclusionsAt least one-third of children with an acute isolated extremity fracture had preoperative gastric contents identified as high risk for pulmonary aspiration. Although preoperative history can guide anesthetic strategy in this population, ultrasound allowed clear stratification of the risk of aspiration in most cases.

Pepsin A in Tracheal Secretions From Patients Receiving Mechanical Ventilation.

In patients in the intensive care unit (ICU) receiving mechanical ventilation, aspiration of gastric contents may lead to ventilator-associated events and other adverse outcomes. Pepsin in pulmonary secretions is a biomarker of microaspiration of gastric contents. To evaluate the association between tracheal pepsin A and clinical outcomes related to ventilator use. A subset of 297 patients from a larger clinical trial on aspiration of oral secretions in adults receiving mechanical ventilation consented to have pepsin A measured in their tracheal aspirate samples. A concentration ≥6.25 ng/mL indicated a positive result. Abundant microaspiration was defined as pepsin A in ≥30% of samples. Statistical analyses included analysis of variance, analysis of covariance, and χ2 tests. Most patients were White men, mean age 59.7 (SD, 18.8) years. Microaspiration was found in 43.8% of patients (n = 130), with abundant microaspiration detected in 17.5% (n = 52). After acuity was controlled for, patients with tracheal pepsin A had a longer mechanical ventilation duration (155 vs 104 hours, P < .001) and ICU stay (9.9 vs 8.2 days, P = .04), but not a longer hospital stay. Microaspiration of gastric contents occurred in nearly half of patients and was associated with a longer duration of mechanical ventilation and a longer stay in the ICU. Additional preventative interventions beyond backrest elevation, oropharyngeal suctioning, and management of endotracheal tube cuff pressure may be needed. Also, the timing of pepsin measurements to capture all microaspiration events requires additional exploration.

Treatment of children with Pierre Robin Syndrome

Introduction. Incidence of Pierre Robin sequence (PRS) according to different studies varies from 1:8500 to 1:30000 newborns. Swallowing dysfunction may lead to aspiration of food, saliva and gastric content, resulting in severe aspirational pneumonia. Obstructive sleep apnea (OSA) may be a life threatening condition for children with PRS and may cause death by asphyxia. Average mortality rate for PRS according to different studies is approximately 16 % and varies depending on several factors: number of patients in studies, severity of the condition, diagnostic methodologies and presence of associated syndromes in maxillofacial region. Mortality rate in severe PSR (especially associated PSR) is 41,4 %. Aside from high mortality, OSA contributes to the development of cardiovascular disease including pulmonary hypertension, which progresses more rapidly than in adults. OSA exacerbates existing comorbidities; in the absence of timely treatment sleep apnea leads to learning impairment and behavioral problems, developmental delay, failure to thrive. Methods. 80 children with PSR aged between 4 days and 1 year have undergone compression-distraction osteosynthesis (CDO). 48,8 % (39) of children were diagnosed with severe degree of OSAS, 35 % (28) had moderate degree, 16,3 % (13) had mild degree. Pretreatment diagnostics included standard set of examinations and specialist consultations. Special diagnostics included CT of head and neck, fiberoptic nasopharyngoscopy, examination by ENT specialist for the assessment of the degree of upper airways obstruction and exclusion of pathologies and anomalies of nasal cavity, pharynx, larynx and trachea, which also may be the cause for reduced airflow and upper airway obstruction (intubated children haven’t undergone these examinations). Photographs were taken and videos of clinical manifestations of airway obstruction during sleep were recorded. Blood gas tests were regularly taken; blood oxygenation levels were measured with a pulse oximeter. Polysomnography was performed, which allows for accurate and comprehensive evaluation of severity of OSA based on multiple parameters. Extra-cortical and external compression-distraction devices (CONMET, KLS Martin, Synthes) were used. Results. Good outcome was achieved in 90 % (72), satisfactory in 6,3 % (5) and negative in 3,8 % (3) of cases.

891 Fasting Times in Trauma List Patients

Abstract Introduction To reduce the risk of regurgitation and aspiration of gastric contents, patients are to fast before anaesthesia. However, prolonged periods of fasting have been found to be unnecessary and potentially harmful. Our aim was to compare pre-operative fasting times in trauma patients against the AAGBI (Association of Anaesthetists of Great Britain and Ireland) guidelines and highlight areas for improvement. The AAGBI recommends minimum fasting periods of: Method 50 patients were audited in each cycle. Data were collected prospectively using questionnaires in the initial audit and by interviewing patients in the re-audit. Patients in ITU and those with dementia were excluded. Questions included fasting instructions given, time of the last meal and drink (including kind of drink), IV fluids administration. Anaesthetic notes were checked for time of induction of anaesthesia. Results Average time fasted for food was 17.09 hours and 9.32 hours for water. In the re-audit, average time fasted was 16.43 hours for food and 5.27 hours for water. All the patients received information as to when they could eat or drink until. None of them was told ‘midnight’. Conclusions Although there was an improvement, this was still beyond the guidelines. The results highlighted the importance of regularly reviewing the fasting status throughout the day in order to achieve the standard.

Pre-induction Ultrasonographic Evaluation of Gastric Residual Volume in Elective Gastrointestinal Cancer Surgeries.

Pulmonary aspiration of gastric contents during elective surgery remains a major cause of airway-related mortality and morbidity. The preoperative fasting times for solids and liquids have been standardized across various anesthesia society guidelines. Enhanced Recovery After Surgery (ERAS) guidelines now advocate liberal clear fluid intake with carbohydrate loading up to 2h preoperatively. The aim of the study was to assess whether practicing both ASA fasting guidelines and ERAS protocol makes the patients prone to a full stomach. The supine position standard curvilinear ultrasound probe (2-5MHz) with Sonosite M-Turbo ©system was used to obtain the images. Gastric residual volume (GRV) was derived from the cross-sectional area (CSA) using the Perlas and colleagues model. A total of 102 patients were recruited and analyzed. The mean age and BMI were 50.65years ± 13.35years and 22.23kg/m2 ± 3.7kg/m2, respectively. A total of four patients (3.92%) had gastric volume > 1.5ml/kg; out of these four patients, three were female and one was male. We did not observe any case of pulmonary aspiration in any of our patients. In conclusion, even though for elective surgeries, the current fasting guidelines are adequate, these findings cannot be extrapolated to patients with risk factors for high gastric residual volume where further studies need to be performed.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

S980 Point of Care Gastric Ultrasound for Predicting Residual Gastric Content and Risk of Aspiration in Ambulatory Patients for Advanced Endoscopy Procedures

Introduction: The risk of aspiration of gastric contents during endoscopy can be associated with significant morbidity and mortality. Even with complete fasting status, the gastric emptying times and residual gastric volumes other than basal secretions vary and depend on many patient factors. Bedside ultrasound imaging can be helpful in determining these gastric contents and volumes while enabling safe anesthesia practices. Our goals were to determine the gastric volume and compare the ultrasound guided gastric volumes in real time with endoscopist measured volumes. Methods: Patients presenting to the UAB endoscopy suite were taken written informed consent to participate in this study. The anesthesiologists experienced in performing gastric ultrasound performed the preoperative gastric ultrasound. The gastric cross-sectional area (CSA) is measured in supine and right lateral decubitus positions and gastric volumes calculated both using the nomograms and the formula. The anesthesia plan intraoperatively is based on the risk profile pattern of these gastric ultrasound estimates. The endoscopist blinded to these gastric ultrasound estimates performed endoscopy to suction the gastric volumes. These direct measured gastric volumes were then compared to calculated gastric volumes (CGV) to assess the degree of correlation and threshold values. Results: 81 patients were included in the study (Mean age 57.78 years, Male 49.38%, Mean BMI 29.83 patients). 2 patients were excluded as there was missing information or technical issues with documentation. Majority of patients underwent EUS (38.27%) followed by EGD ± therapy (30.86 %) ERCP (22.22%) and DBE (6.17 %). Mean CGV by nomogram is 33.84 ml, mean CGV by formula is 30.79 ml. Mean measures gastric volume by endoscopist is 28.64 ml. The gastric ultrasound was able to predict correlation significantly comparing measured gastric volume by endoscopy (ml) to CGV measured by nomogram (0.794, 95% CI for Pearson correlation (0.697-0.863) (Figure A) and measured gastric volume by endoscopy (ml) to CGV by formula (r=0.834 95% CI for Pearson correlation (0.753-0.890) (Figure B). There were no intra or post procedural adverse events noted in particular for aspiration. Conclusion: Gastric ultrasound acts as a reliable tool in predicting residual gastric volume and contents prior to undergoing anesthesia for advanced endoscopy procedures. This can potentially offer and guide preventive measures to prioritize on airway protection.Figure 1.: Measured gastric vol by

Предоперационная подготовка и особенности индукции в анестезию при острой кишечной непроходимости (клиническая лекция)

В статье представлены основные направления предоперационной подготовки в случае тяжелой острой кишечной непроходимости (ОКН) и подчеркнуто, что данная подготовка должна быть ограниченной во времени и не задерживать проведение оперативного вмешательства. При тяжелой ОКН вместе с тщательной оценкой витальных функций и определением ведущих нарушений крайне важно оценить больного по шкалам и определить основные риски развития осложнений. Общая анестезия, как правило, является методом выбора при ОКН, однако для улучшения интра- и послеоперационного обезболивания она может быть дополнена и методами регионарной анестезии. При подготовке к проведению общей анестезии в первую очередь следует определять риски сложной интубации, а также регургитации и аспирации желудочного содержимого, что позволяет целенаправленно подходить к выбору техник интубации и предотвращать возникновение этих грозных осложнений. Прием Селлика уже не обязателен для использования у таких пациентов, а вместо него во время интубации может быть применена бимануальная ларингоскопия. Артериальная гипотензия является частым осложнением во время индукции в анестезию при тяжелой ГКН, и у таких больных всегда следует проводить инфузионную терапию, а также коррекцию водно-электролитных нарушений. Вместе с тем для предотвращения отека кишечника и развития интраабдоминальной гипертензии инфузионная терапия должна быть ограничена как во времени, так и в объеме. Если невозможно полностью скорректировать гиповолемию, для снижения риска возникновения существенной артериальной гипотензии во время индукции в анестезию быстрой последовательности следует с профилактической целью назначать вазопрессоры.

Using gastric ultrasound to assess gastric content in the pregnant patient

Perioperative pulmonary aspiration of gastric content can lead to prolonged tracheal intubation, hospitalisation, aspiration pneumonitis and pneumonia.1 Unfortunately, the risk of aspiration is often estimated by fasting time, not accounting for comorbidities that affect gastric emptying, such as labour. Bedside point-of-care ultrasound (POCUS) of gastric content is a validated tool that allows the anaesthetist to assess the qualitative and quantitative content of the stomach.2 This technique has been used and validated in pregnant women to define the cut-off values for the risk of aspiration.

The causes of hospital mortality in methadone associated poisonings: analysis of the data from the Kyiv toxicological center for 2005–2019

Scientific interest in poisoning by synthetic opioids, in particular Methadone, is due to a significant increase in their number in Kyiv over the past 15 years and fatal consequences. The Aim of the Research. Is to identify the causes of fatal poisoning associated with methadone and to determine measures to prevent them. Materials and Methods. A retrospective analysis of medical data of 1340 patients with Methadone poisoning who were treated at the Toxicology Center in Kyiv in the period 2005–2019; including 38 fatalities cases. Results. The share of drug poisonings registered at the Kyiv Toxicology Center has increased from 15% to 42% over the past 30 years. The top five drugs and psychotropic substances in 2019 were Benzodiazepines, Methadone, Barbiturates, Amphetamines, and Marijuana. The number of Methadone poisonings in 2005–2014 increased 150 times. The main cause of poisoning is the use of illegal Methadone. There is a direct relationship between the growth of hospital mortality and the appearance of combined poisonings: Methadone-Ethanol (r = 0,79); Methadone-Ethanol-Amphetamines (r = 0,69); Methadone-Ethanol-Benzodiazepines (r = 0,61); Methadone-Ethanol-Cocaine (r = 0,43). According to the results of forensic medical studies of 38 patients who died as a result of Methadone poisoning, the following were identified: toxic hepato-nephropathy – 12 cases (31,57%); long-term soft tissue compression syndrome – 10 (26,31%); acute kidney damage – 4 (10,52%); aspiration of gastric contents – 7 (18,42%); apallic syndrome – 4 (10,52%). The direct effect of polymorbidity on mortality has been confirmed, which justifies the need for a personalized approach to intensive care. Conclusions. Today in Ukraine, combined illegal methadone poisoning is the most common type of drug poisoning, which has a severe course, high mortality, and requires long and complex treatment. Key Words: acute poisoning, methadone, combined poisoning, mortality.

An uncommon etiological factor for aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with cerebrospinal fluid rhinorrhea: a case report

BackgroundAspiration pneumonitis is an inflammatory disease of the lungs which is difficult to diagnose accurately. Large-volume aspiration of oropharyngeal or gastric contents is essential for the development of aspiration pneumonitis. The role of cerebrospinal fluid (CSF) rhinorrhea is often underestimated as a rare etiological factor for aspiration in the diagnosis process of aspiration pneumonitis.Case presentationWe present a case of a patient with 4 weeks of right-sided watery rhinorrhea accompanied by intermittent postnasal drip and dry cough as the main symptoms. Combined with clinical symptoms, imaging examination of the sinuses, and laboratory examination of nasal secretions, she was initially diagnosed as spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, and intraoperative endoscopic findings and postoperative pathology also confirmed this diagnosis. Her chest computed tomography showed multiple flocculent ground glass density shadows in both lungs on admission. The patient underwent endoscopic resection of meningoencephalocele and repair of skull base defect after she was ruled out of viral pneumonitis. Symptoms of rhinorrhea and dry cough disappeared, and pneumonitis was improved 1 week after surgery and cured 2 months after surgery. Persistent CSF rhinorrhea caused by spontaneous sphenoid sinus meningoencephalocele was eventually found to be a major etiology for aspiration pneumonitis although the absence of typical symptoms and well-defined risk factors for aspiration, such as dysphagia, impaired cough reflex and reflux diseases.ConclusionsWe report a rare case of aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, which can bring more attention and understanding to the uncommon etiology for aspiration, so as to make more accurate diagnosis of the disease and early surgical treatment.

This Month in Anesthesiology

This Month in Anesthesiology

ID: 3526606 FEASIBILITY OF BEDSIDE GASTRIC ULTRASOUND AS A PRE-PROCEDURE PREDICTOR FOR RESIDUAL GASTRIC CONTENTS AND SAFE ANESTHESIA AIRWAY MANAGEMENT PLAN IN AMBULATORY PATIENTS FOR ADVANCED ENDOSCOPY PROCEDURES

The risk of aspiration of gastric contents can be associated with significant morbidity and mortality in anesthesia clinical practice and for deep sedation for endoscopy (ASGE). Even with complete fasting status, the gastric emptying times and residual gastric volumes other than basal secretions vary and depend on patient factors. Bedside ultrasound imaging can be helpful in determining gastric contents and volumes while enabling safe anesthesia practices Few studies have documented the feasibility in GI patients. We aimed to determine gastric volumes in patients presenting for advanced endoscopic procedures by comparing the ultrasound guided gastric volumes with endoscopist measured volumes.

Donation after circulatory death (DCD)-lung procurement.

The number of lungs available for lung transplantation is far lower than the number of patients awaiting them. Consequently, there is a significant attrition rate while awaiting transplantation. Lung procurement rates are lower than those of other solid organs. Lungs are procured from only 15–20% of donors compared with 30% of decreased donors for hearts. The reason for this low retrieval rate is related to a number of factors. Brain death is associated with neurogenic pulmonary edema. Additionally, injury to the lung itself may occur before or after brain death. Aspiration of gastric contents, pneumonia, previous thoracic trauma, ventilator-associated injury, atelectasis, and pulmonary thrombosis/embolism may all contribute to lung injury before consideration for harvest. Donation after circulatory death (DCD) is one category of nontraditional organ donation now being performed in increasing numbers as a way to increase the number of lungs available for transplantation. In some studies, estimates show that utilization of DCD lung procurement could increase the number of lungs available by up to 50%.