Risk Of Aspiration Research Articles

Line Spread Test Results for Commercially Available the White Rice Porridge with Salted Plum - Including the Effect of Four Types of Thickening Agents Added after Blending

We added four commercially available thickeners to white rice porridge with salty plum, which is popular in Japan, and compared the viscosity. Porridge containing water is useful even in the event of a disaster. In Japan, porridge is useful as a stockpile of food during disasters. Porridge is used as a meal of a wide range of age groups, form the elderly to infants. However, if porridge is made into a liquid using a mixer, etc., it becomes a food with a high risk of aspiration for people with impaired swallowing function. Therefore, it is necessary to add a thickener to the liquid porridge to increase its viscosity. In order to keep the consistency, the thickening agent should be changed according to the amount of nutrients contained in the porridge.

Comparison of Postextubation Complications Between Positive-Pressure and Suctioning Techniques: A Systematic Review.

Several studies have investigated postextubation complications of the positive-pressure and suctioning techniques; however, these studies yielded inconsistent results. Therefore, in this systematic review, we aimed to assess and compare the risk of complications between these techniques after extubation. This study was registered with the International Prospective Register of Systematic Reviews (CRD42021272068). We searched for randomized controlled trials (RCT) or observational studies that compared positive-pressure and suctioning extubation techniques in medical literature databases. Our search was conducted from the databases' inception to July 7, 2022. The included studies were assessed for quality by using a risk of bias tool. Six RCTs and 1 non-randomized controlled study were included in this systematic review (N = 1,575 subjects), wherein the positive-pressure and suctioning techniques were applied to 762 and 813 subjects, respectively. Three studies were conducted in operating rooms, and 4 studies were conducted in ICUs. Five studies were conducted among adults, and 2 studies were conducted among children or neonates. All the studies except 1 RCT showed that the positive-pressure technique tended to have a lower but not statistically different risk of complications, including desaturation, airway obstruction, pneumonia, aspiration, atelectasis, and re-intubation, than the suctioning technique. Three of the 6 RCTs were determined to have a high risk of bias and the 1 non-randomized controlled study was determined to have a serious risk of bias. The positive-pressure technique tended to have a lower risk of complications than the suctioning technique. Further high-quality studies are warranted.

The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients.

Although gastric reserve volume (GRV) is a surrogate marker of gastrointestinal dysfunction and feeding intolerance, there is ambiguity in its estimation due to problems associated with its measurement. Introduction of point-of-care ultrasound as a tool for anesthetists kindled interest in its use for GRV estimation. In this prospective observational study, we recruited 57 critically ill patients and analyzed 586 samples of GRV obtained by both ultrasonography (USG) and manual aspiration. The analysis showed that USG-guided GRV was significantly correlated (r=0.788, P<0.001) and in positive agreement with manual aspiration based on Bland-Altman plot, with a mean difference of 8.50±14.84 (95% confidence interval, 7.389-9.798). The upper and lower limits of agreement were 37.7 and -20.5, respectively, within the ±1.96 standard deviation (P<0.001). The respective sensitivity and positive predictive value, specificity and negative predictive value, and area under the curve of USG for feeding intolerance were 66.67%, 98.15%, and 0.82%, with 96.49% diagnostic accuracy. Ultrasonographic estimation of GRV was positively, significantly correlated and in agreement with the manual aspiration method and estimated feeding intolerance earlier. Routine use of gastric USG could avoid clinical situations where feeding status is unclear and there is high risk of aspiration and could become a standard practice of critical care.

Carbohydrate Loading and Aspiration Risk in Bariatric Patients: Safety in Preoperative Enhanced Recovery Protocols.

Enhanced recovery protocols have been developed to improve perioperative outcomes; however, there is ongoing concern for aspiration with recent oral intake in patients with obesity, who may be predisposed to impaired gastrointestinal motility and greater gastric volumes. We aim to study the safety of a 300-mL preoperative carbohydrate-loading drink preceding bariatric surgery. Data were collected prospectively from patients undergoing primary bariatric surgery. All bariatric patients at our institution are prescribed a proton pump inhibitor for 4 weeks before surgery and undergo a screening preoperative esophagogastroduodenoscopy (EGD) before surgery with a traditional 8-hour fast (NOCARB), followed by an intraoperative day-of-operation EGD with carbohydrate loading (CARB) 2 to 4 hours before incision. Gastric volumes and pH are measured after being endoscopically suctioned via direct visualization during both settings. We identified 203 patients: 94 patients (46.3%) in the CARB group and 109 patients (53.7%) in the NOCARB group. The patients were 82.3% female with a mean age of 42.8 years and average BMI of 41.7 kg/m 2 . There was no difference in gastric volume between NOCARB and CARB (17.0 vs 16.1 mL, p = 0.59). The NOCARB group had lower pH values than the CARB group (2.8 vs 3.8, p = 0.001). Subset analysis of 23 patients who had measurements on both screening and intraoperative EGD revealed lower gastric volumes in CARB patients (13.3 vs 18.3, p < 0.0001). When included in an enhanced recovery protocol, proton pump inhibitor use and preoperative carbohydrate loading 2 to 4 hours before bariatric surgery does not increase aspiration risk based on gastric volumes and pH and should be strongly considered in all eligible bariatric patients.

Reducing the use of nil per os past midnight for inpatient diagnostic and therapeutic procedures: A quality improvement initiative.

Pre-procedural fasting (nil per os[NPO]) is a commonly implemented protocol to prevent aspiration during certain diagnostic and therapeutic procedures. However, evidence suggests aspiration risk is quite low. Current guidelines support a reduced fasting duration before procedures necessitating anesthesia or sedation, but many health systems persist in the use of NPO past midnight. We aimed to reduce the use of NPO p MN before inpatient diagnostic and therapeutic procedures necessitating anesthesia or sedation by 50% within 6 months. We performed a quality improvement initiative at a single academic health system in Southeast Texas. We include the experience of patients of all ages across 4 affiliated hospitals (one main academic hospital and three community satellite hospitals). An interprofessional team was convened to review best practices and oversee this quality improvement initiative. Diagnostic imaging protocols previously requiring NPO were amended to reflect evidence-based fasting requirements. A pre-procedure clear liquid diet was also implemented. We describe the steps to implementation, feasibility of implementation as described through key process measures, and the safety of implementation (balancing measures). NPO requirements were removed from 70% of existing diagnostic imaging and therapeutic orders. After these amended protocols and the implementation of a pre-procedure clear liquid diet, we displayed an immediate 50% reduction in NPO past midnight usage. Further stakeholder engagement/education and targeted interventions reduced NPO past midnight usage to only 33% of pre-procedural diet orders. Surgery remains the most common indication for continued use of NPO. Aspiration events and procedural delays were rare.

The importance of shear and extensional rheology and tribology as the design tools for developing food thickeners for dysphagia management

Food texture manipulation and modification is a practical strategy to reduce the risk of aspiration for dysphagia management. Addition of thickening agent to thicken liquid can increase the bolus transit time, thus, potentially leading to safer swallowing. The important bolus characteristics for safe swallowing include viscosity, hardness, cohesiveness, and adhesiveness, which can be related to the rheological and tribological properties of bolus. Therefore, this work highlights the importance of shear and extensional rheology and tribology as the design tools for developing dysphagia food thickeners. A range of commercially available thickening powders (xanthan gum-, guar gum-, and modified starch-based) was studied to create baseline rheological and tribological data. In general, it was observed that the increase in thickener concentration led to increases in shear viscosity, viscoelastic properties, and extensional viscosity, but the impact on tribological behavior was varied depending on the type of thickener and lubrication regime. It was also revealed that, at the same liquid consistency based on IDDSI classification, xanthan gum-based thickener showed the highest low shear viscosity, extensional viscosity, and lubricating capacity than the other thickeners. More specifically, modified starch-based thickener showed the poorest extensional property and could be the least effective thickener for promoting safer swallowing. The proposed design tools may be used beneficially to tailor novel thickeners for dysphagia management based on the obtained baseline data. Nonetheless, in-depth knowledge on the relationship between these properties and in-vivo measurements of swallowing is still required and is key to achieve the most effective therapeutic strategy in the dysphagia treatment.

Predicting the clinical trajectory of feeding and swallowing abilities in CHARGE syndrome

To date, the feeding and oral-motor abilities of patients with CHARGE syndrome (CS) have not been longitudinally assessed. This study aims to investigate the level of these abilities at different ages and evaluate how they evolve during growth. We retrospectively analysed oral-motor features of 16 patients with molecularly confirmed CS (age range 4–21 years old; mean 11 years; SD 6 years; median 10 years). Nearly 100% of CS new-borns had weak sucking at birth, and half of them demonstrated poor coordination between breathing and swallowing. Over time, the percentages of children with tube feeding dependence (60% at birth) faced a slow but steady decrease (from 33% at 6 months, 25% at 12 months, to 13% at school age) in tandem with the decreasing risk of aspiration. The ability of eating foods requiring chewing was achieved at school age, after the acquisition of an adequate oral sensory processing. A mature chewing pattern with a variety of food textures was not achieved by more than half of patients, including those requiring artificial enteral nutrition. Most patients started prolonged oral-motor treatments with speech language therapists in early childhood.Conclusions: Although feeding and swallowing disorders are constant features in CS patients, a slow and gradual development of feeding abilities occurs in most cases. Rehabilitation plays a key role in overcoming structural and functional difficulties and attaining appropriate eating skills.What is Known:• Feeding problems and swallowing dysfunction have been noted in CHARGE syndrome.• The involvement of multiple factors, including structural problems in the mouth, throat, or esophagus, and neurological impairment, make feeding a complicated task in CHARGE individuals.What is New:• Dysphagia gradually improves in most CHARGE children over time, though with a wide interindividual variability.• The percentages of children with tube feeding dependence decrease over time from 60% at birth to 33% at 6 months and 13% at school age.

Procedure, Screening, and Cost of Fecal Microbiota Transplantation.

Fecal microbiota transplantation (FMT) is currently considered a potential treatment for various GI-related illnesses, with the goal to replenish natural healthy flora of the GI tract that has been harmed because of antibiotic use or overgrowth of harmful bacteria. Current methods of administering the processed stool include colonoscopy and enema, while an oral capsule is being developed. Each method of administration carries its own set of risks, including adverse reactions to treatment, infection following the invasive administration procedure, and flare-ups of GI-related symptoms. Current oral administration through nasoduodenal tube poses a risk for aspiration which has not been ruled out as the cause of subsequent pneumonia and death in patient trials. The development of an oral capsule could address some of the faults of the current methods, not only making treatment more affordable and accessible but also less of a risk due to its minimally invasive nature. FMT is also a treatment option to attenuate adverse effects associated with antibiotic use, including combatting the emergence of antibiotic resistance, as well as adverse effects related to other medical treatments such as chemotherapy. While FMT is an unexplored treatment option for multiple gastrointestinal disorders and is currently still largely inaccessible for many patients financially, studies have suggested that it could be a more affordable treatment option long-term for patients as aspects of the treatment become more affordable with further research.

Ultrasound assessment of gastric contents and volume in patients undergoing endoscopic endonasal transsphenoidal surgery: a prospective observational study

Intraoperative ingestion of blood, cerebrospinal fluid, and irrigation fluid can lead to an increase in gastric volume, resulting in the potential risk of aspiration in patients after endoscopic endonasal transsphenoidal surgery (EETS). In this prospective observational study, we aimed to assess the volume of gastric contents in patients undergoing this neurosurgical procedure using ultrasound, and to determine the factors associated with volume change. Eighty-two patients diagnosed with pituitary adenoma were recruited consecutively. Semi-quantitative (Perlas scores: 0, 1 and 2) and quantitative (cross-sectional area, CSA) ultrasound assessments of the gastric antrum were performed immediately before and after surgery in the semi-recumbent and semi-recumbent right-lateral positions. Seven (8.5%) patients had antrum scores from preoperative grade 0 to postoperative grade 2; nine (11%) patients had antrum scores from preoperative grade 0 to postoperative grade 1. The mean ± standard deviation (SD) of increased gastric volume was 71.0 ± 33.1 mL and 236.5 ± 32.4 mL in postoperative grade 1 and 2 groups, respectively. Subgroup analysis showed that 11 (13.4%) patients (4 in grade 1 and all in grade 2) had postoperative estimated gastric volume > 1.5 mL kg−1 (mean ± SD 3.08 ± 1.67, range 1.51–5.01 mL kg−1). Logistic regression analysis revealed that older age, diabetes mellitus, and long surgical duration were independent risk factors for significant volume change (all P < 0.05). Our results showed a significant increase in gastric volume in some patients who underwent EETS. Bedside ultrasound measurements of gastric volume can be used to assess the postoperative aspiration risk, particularly in older diabetic patients with a longer surgical duration.

FraMaDySc: dysphagia screening for patients after surgery for head and neck cancer

PurposeOropharyngeal dysphagia is one of the most common postoperative consequences in head and neck cancer patients. Above all, these patients often suffer from aspiration and limitations of oral intake. However, no reliable dysphagia screening is available for this target group. This study aimed to develop and validate a screening, FraMaDySc, based on a water swallow test (WST) for the identification of postsurgical patients with a risk of aspiration, limitations of oral intake, and, as their derivate, a relevant oropharyngeal dysphagia in general (OD) that constituted the main reference standard.MethodsA total of 184 postsurgical head and neck cancer patients were tested with a WST. The patients were, on average, 62 years old and predominantly male (71%). After WST, they underwent Fiberoptic Endoscopic Evaluation of Swallowing (FEES®). FEES® results were dichotomized by Penetration aspiration scale and Functional oral intake scale. Patients with a “fail” result on one of these two scales were classified as having OD. Quality criteria of WST were quantified by means of cross-tabulation with FEES® results.ResultsOD was found in 65% of patients, aspiration in 44%, limitations of oral intake in 56%. WST delivered a “fail” result in 65% of patients. WST showed sensitivity 91% and specificity 88% for OD. Quality criteria for aspiration (sensitivity 64%, specificity 93%) and limitations of oral intake (sensitivity 80%, specificity 87%) were lower.ConclusionFraMaDySc is a standardized, quick, and valid WST and therefore an excellent screening tool for the identification of OD in postoperative head and neck cancer patients.

Assessment of residual gastric volume using point-of-care ultrasonography in adult patients who underwent elective surgery

BackgroundAspiration pneumonitis remains a dreaded complication that may lead to almost 9% of anaesthesia-related deaths. The presence of gastric contents has always been a contributing factor to an increased risk of aspiration. Preoperative gastric ultrasound has been suggested as a modality for determining residual volume in special populations and conditions. We conducted an observational study to determine the gastric residual volume in preoperative patients of elective surgery with gastric ultrasound and to study its correlation with patient factors.MethodsWe enrolled 411 patients in the age group of 18–80 with ASA-PS I and II having BMI less than 35 kg/m2. Patients with prior gastrointestinal surgery and parturients were excluded from the present study. Gastric antrum in both supine and right lateral decubitus positions was measured using USG in the immediate preoperative period, and gastric residual volume was calculated, which was subsequently correlated with various patient factors.ResultsOn qualitative assessment, 97 and 118 patients were observed to have distended stomachs in the supine and right lateral decubitus positions, respectively. On quantitative assessment, 336 had safe GRV, 60 patients were classified as having a low risk of aspiration (GRV < 1.5 ml/kg) while 13 had a high risk of aspiration (> 1.5 ml/kg). Eight patients with a fasting duration of more than ten hours and five who fasted between 6 and 10 h had a gastric residual volume of more than 1.5 ml/h. Patients who were premedicated with histamine blockers had a statistically significant higher antral cross-sectional area (p-value − 0.022*) and GRV (p-value − 0.018*) in the right lateral decubitus position compared to patients who had taken proton pump inhibitors (PPIs). As BMI increased, there was a statistically significant (p-value < 0.001) increase in mean antral CSA in both supine and right lateral decubitus positions. There was a statistically significant association found between type 2 diabetes (p-value 0.045*) with antral grade.DiscussionPatients can have significant residual volume (> 1.5 ml/kg) despite adequate fasting, and preoperative gastric ultrasound can help in assessing the same and guiding perioperative airway management. PPIs are more effective in reducing gastric residual volume as compared to histamine blockers. Patients with a BMI of more than 30 and type 2 diabetes mellitus have significant correlation with increased gastric residual volume mandating preoperative gastric ultrasound assessment for effective management.ConclusionsPatients with BMI over 30 and type 2 diabetes may benefit from POCGUS to guide perioperative airway management by stratifying GRV.Trial registration Name of registry-Clinical Trial Registry of India. Trial registration number-2020/03/024083. Date of registration-19.3.2020. URL-http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=39961&EncHid=&userName=

Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: outcomes of a dedicated anesthesia and surgery protocol.

Patients requiring percutaneous endoscopic gastrostomy (PEG) for amyotrophic lateral sclerosis (ALS) related dysphagia represent a clinical challenge. Diminished pulmonary function and aspiration risks can lead to anesthesia-related complications, and gastric displacement from hemidiaphragm elevation may preclude safe gastric access. This study reports the efficacy and outcomes of a dedicated anesthesia/surgery management protocol for ALS patients undergoing PEG. In 2013, a PEG placement protocol for ALS patients was developed emphasizing efficient pre-operative evaluation, rapidly metabolized anesthetic agents, and minimization of opioid use. Outcomes were analyzed retrospectively. Preoperative weight loss, pulmonary function tests, total analgesia, procedural time, and 90-day morbidity and mortality were recorded. From 2013-2019, 67 ALS patients (mean age 65.3years, 52.2% female) received a PEG under the protocol. Mean percentage weight loss 6months before PEG was 9.3 ± 5.1% with 38.8% of patients meeting criteria for severe malnutrition. Mean anesthesia time (propofol induction to anesthesia emergence) was 34.5 ± 10.8min and mean operative time (endoscope insertion to dressing placement) was 16.4 ± 8.2min. Regional anesthesia with liposomal bupivacaine was performed in 76.1%. All attempts at PEG placement were successful. With a mean follow-up of 6.1 ± 6.8months, all PEGs were functional and there were no surgical site complications. Thirty-day readmission rate was 7.0% and 90-day mortality was 22.4% (46.7% occurring within 30days). Mean time from surgery to death was 8.8 ± 7.8months. Protocols for optimizing PEG may help overcome challenges present in the ALS patient population. Despite patient comorbidities, protocol implementation and dedicated team members resulted in a high procedural success rate and low complication rate. Further study is warranted to optimize the timing of PEG placement in relation to ALS disease progression and determine the utility of regional anesthesia during PEG placement.

A case of displaced mandibular reconstruction plate and the airway

Difficult airway is a common problem encountered in oro-maxillo-facial surgeries. We describe a case where a displaced mandibular reconstruction plate obstructing the access to oral cavity. The airway was further compromised by previous tracheostomy, and limited neck extension owing to previous surgeries and radiotherapy. The inability of the patient to swallow increased the risk of pulmonary aspiration. The first line of airway management in such patient should be fibro-optic laryngoscopy. However, one must have alternative plans for securing airway if there are expected difficulties with fiberoptic laryngoscopy. Such plans were made considering her clinical presentation. We believe this case highlights the importance of pre-planning the strategies for airway management according to the presentation.&#x0D; Key words: Difficult airway; Oro-maxillary-facial surgeries; Fiberoptic intubation; Mandibular reconstruction&#x0D; Citation: Ratnayake A, Nanayakkara S, Herath M. A case of displaced mandibular reconstruction plate and the airway. Anaesth. pain intensive care 2022;27(1):139−141; DOI: 10.35975/apic.v27i1.2126&#x0D; Received: September 24, 2022; Reviewed: November 15, 2022; Accepted: November 15, 2022

Using an Electromagnetic Guidance System for Placement of Small-Bowel Feeding Tubes to Reduce Feeding Start Times.

Cardiothoracic surgery patients have an increased risk for aspiration and may require enteral access for nutrition. In a cardiothoracic intensive care unit, feeding start times were delayed because of scheduling conflicts with support services. An electromagnetic device (Cortrak 2 Enteral Access System, Avanos Medical) was introduced to allow advanced practice providers (nurse practitioners and physician assistants) to independently establish postpyloric access and reduce dependence on ancillary services. A quality improvement study was performed. Pre- and postimplementation data included order time, service arrival, tube placement time, tube positioning, and feeding start times for 207 placements. Pre- and postimplementation surveys were conducted to evaluate advanced practice provider satisfaction with enteral tube placement practices. Feeding start time for initial placement decreased by 35.5% (15.6 hours to 10 hours); for subsequent placement, by 55.2% (15.5 hours to 7.0 hours). Assistance by support services decreased by 80.4% (before implementation, 100 of 100 placements [100%]; after implementation, 21 of 107 placements [19.6%]; P < .001; ϕ = 0.815). Overall, advanced practice provider satisfaction increased. Most participants said that using the electromagnetic device was faster, nutrition was delivered sooner, and implementation was a valuable practice change. Using an electromagnetic device decreased feeding start times, reduced the need for support services, and increased advanced practice provider satisfaction with small-bowel feeding tube placement practices.

Abstract WMP17: Impact Of Nursing Education And Implementation Of Evidenced Based Dysphagia Screening

Introduction: Dysphagia is a complication experienced in patients with acute stroke. Complications can lead to aspiration pneumonia, swallowing difficulties, inadequate nutrition, and increased healthcare costs. Guidelines for stroke care require that stroke patients must be screened for dysphagia before eating, drinking, or receiving oral medications. Registered Nurses (RNs) play a vital role in screening for dysphagia and when provided with the appropriate education are better equipped to assess for dysphagia risk and intervene as needed. The purpose of the study is to determine whether RNs at a hospital in a Midwestern State, who complete a dysphagia screening education, demonstrated knowledge acquisition prior to implementing the Yale Swallow Protocol (YSP). The YSP is an evidenced-based screening tool that identifies aspiration risk and when passed, can recommend oral diets without the need for further instrumental dysphagia testing. Implementation of the YSP required RN education project to increase knowledge and competency for dysphagia screening. Method: This summative study utilized a tracking tool that compared results of a ten-item pre-test and post-test. Summative evaluation was directly related to the identified learning objectives and measured RNs knowledge acquisition. Results: Fifty-seven subjects complete the study. The results were analyzed via paired t test, which showed a statistically significant difference between the pre-test and post-test scores (t = 6.254, df = 56, p = .000), which suggest that the educational activity had a positive impact on learner knowledge. This education promotes positive social change by increasing RNs’ knowledge, confidence, and competence when caring for stroke patients, thus increasing patient quality of care. Conclusion: Project findings showed dysphagia screening education had an impact on knowledge acquisition. In addition, completion of the dysphagia screen education provided the necessary tools and resources to implement use of the YSP at the specialty care hospital. In addition, training will help prevent disparities in the way patients are screened for dysphagia.

An agar structured fluid prepared by pipe wall shear as a dysphagia diet

The risk of dysphagia in the elderly has gradually become a social problem. An important strategy is to modify the food texture to reduce aspiration risk. The microgel, a structured fluid prepared usually by Couette flow and jacketed stirring, has attracted much attention due to its unique rheological properties and complex microstructure. This study proposed a continuous production process of agar structured fluid through the pipe wall laminar shear. The rheological properties and particle size distribution of agar microgel were characterized. The morphology of microgel and its interaction with water molecules were examined through scanning electron microscopy (SEM) and low-field nuclear magnetic resonance (LF-NMR), and some positive feedback examples were obtained through the Videofluorographic swallowing study (VFSS). A molecular model was proposed that agar microgel is a supramolecular structure with a multi-domains weak interaction, whose “hairy” structure is the site of domain-domain interaction. The agar microgel as a structured fluid can achieve higher yield stress and elastic modulus at the same concentration compared to xanthan gum solution, which is expected to be the next cost-effective and age-appropriate pre-thickened diet for older adults with dysphagia.

Application of Cold Drink in Post Operation Nausea and Vomiting (PONV) Appendectomy Cases in Lubuklinggau

Introducition: Post Operative Nausea and Vomiting (PONV) is one of the most common complications after surgery, it affects the patient's time recovery and causes discomfort including: pain, electrolyte imbalance, dehydration, risk of aspiration, risk of wound opening and bleeding. The purpose of this study was to see a decrease in postoperative nausea and vomiting scores.&#x0D; Methods: The research design used was quasi-experimental with 2 pre-post test groups. The sample in this study were 42 people with a total of 21 people in the intervention group and 21 people in the control group. The variable in the study looked at the score of postoperative nausea and vomiting. Instruments used by Rhodes INVR. Data analysis used SPSS test with Mann-Withney.&#x0D; Results: There was a significant difference in respondents' scores (p-value = 0.000, &lt; 0.05). In addition, it showed a difference in the average score of the test between the control group (19.00) and the invention group (3.00), with an average difference of 16.00.&#x0D; Conculsion: The application of cold drinks in PONV has proven to be more effective in reducing vomiting nausea. This method can be used as an alternative method in meeting the needs of body fluids when getting complaints of nausea vomiting. To achieve the goal of preventing the occurrence of the impact of vomiting nausea such as preventing dehydration.

Practice Patterns and Outcomes of Patients with Retained Gastric Food Content Encountered during Endoscopy.

Retained gastric food content encountered during upper endoscopy may reduce diagnostic accuracy and increase the risk of aspiration. To evaluate endoscopists' practice patterns and clinical outcomes in patients with retained gastric food content encountered during endoscopy. Consecutive patients with retained gastric food content during first-time endoscopy at Loma Linda University Health (1/2016-3/2021) were identified. Primary endpoints were complete examination (deep duodenal intubation) and 30-day post-procedural respiratory adverse events. Of 17,868 patients undergoing endoscopy, 629 (3.5%) (mean age 55+17 years) met inclusion criteria. Moderate sedation was used in 506 (80.4%), anesthesiologist-assisted sedation in 16 (2.5%), and general anesthesia in 107 (17.0%) patients. 534 (84.9%) patients received complete examination, and endoscopist-specific completion rates varied by quintile among 26 endoscopists (range 70.3-98.0%, P<0.0001). Large food gastric content decreased (AOR=0.3, 95%CI 0.2-0.4) while obtaining mucosal biopsies increased (AOR=2.5, 95%CI 1.4-4.7) the likelihood of complete examination after adjusting for endoscopist-specific completion rates. Subsequently, 58 (9.2%) patients required repeat endoscopy within 30 days. During follow-up, 41 (6.5%) patients developed respiratory adverse events including 21 (3.3%) requiring ventilatory support. Hospitalized patients (AOR=37.8, 95%CI 4.9-289.0) compared to outpatients and large compared to small gastric food content (AOR=2.1, 95%CI 1.1-4.2) increased the likelihood of respiratory adverse events. Although deep duodenal intubation was achieved in most patients receiving endoscopy, the rate of complete examination varied among individual endoscopists and the extent of food burden. Respiratory adverse events occurred almost exclusively in hospitalized patients and were associated with high morbidity including half developing respiratory failure.

The role of supraglottic airway devices in obstetric anaesthesia.

To discuss the role of supraglottic airway devices as rescue and primary airway devices in pregnant patients. General anaesthesia in pregnant patients is associated with increased incidence of difficult and failed intubation, especially when performed for caesarean deliveries. The Difficult Airway Society and the Obstetric Anaesthetists' Association guidelines for the management of failed intubation recommend the use of second-generation supraglottic airway devices as a rescue airway strategy when failed intubation occurs. This practice is now widely accepted and embedded in routine teaching and clinical practice. On the other hand, there is little but growing evidence describing the use of supraglottic airway devices as the primary airway device and an alternative to endotracheal intubation for patients undergoing elective and emergency caesarean deliveries under general anaesthesia. Most of the published research supporting this practice was done on carefully selected patients who were nonobese and who did not have gastroesophageal reflux or anticipated difficult airway. Despite demonstrating high insertion success rates and low complication rates, these studies were underpowered and have thus far, failed to provide robust data on the true risk of aspiration in this setting. Based on current scientific data, the evidence for the safe use of supraglottic airway devices as primary airway devices during general anaesthesia for caesarean deliveries is not compelling. However, their use as rescue airway devices remains a well established strategy supported by international guidelines.

A Comparative Study of Fasting Gastric Volume in Diabetic and Non-diabetic Patients Undergoing Elective Surgeries Using Ultrasonography: A Prospective Observational Study.

Gastric ultrasound can be used to evaluate the residual gastric volume (GV) and contents before anesthetizing a patient. Autonomic gastropathy in patients with diabetes increases the risk of pulmonary aspiration of gastric contents. Therefore, the present study was conducted to assess the fasting GV among diabeticsand healthy individuals using point-of-care (POC) ultrasonography. This prospective observational study was conducted in a tertiary care hospital between January 2021 and February 2022. A total of 122 patients included in the study were divided into two groups: group D (n = 61) patients had a history of diabetes mellitus and group C (n = 61) patients were non-diabetics (control).Gastric ultrasound was performed in supine and right lateral decubitus (RLD) positions. The following parameters were measured: duration of fasting, craniocaudal (CC) diameter, anteroposterior (AP) diameter, cross-sectional area (CSA), and GVusing CC and AP diameters. The mean age of the participants was found to be 46.60 ± 13.77 years with 51.6% femalepatients and 48.4% male patients. Among the patients, there was a significantly higher mean level of CC diameter, AP diameter, and CSA in the supine position in diabetics compared to controls(p < 0.05). Similarly, there was a significantly higher mean level of CC diameter, AP diameter, and CSA in the RLD position in diabetics compared to healthy individuals (p < 0.05). The GV was significantly higher in diabetics (9.96 ± 14.520) compared to healthy individuals (-8.991 ± 20.95; p < 0.05). Fasting GV assessed using POC ultrasonography in diabetic individuals was higher when compared to non-diabetics after similar periods of fasting.