Risk For Aspiration Of Gastric Contents Research Articles

Anesthesia for digestive tract endoscopy.

Nonoperating room anesthesia for digestive tract endoscopy has its own specificities and requires practical training. Monitoring devices, anesthetic drugs, understanding of procedures and management of complications are critical aspects. New data are available regarding risk factors for intra- and postoperative complications (based on anesthesia registries), airway management, new anesthetic drugs, techniques of administration and management of advances in interventional endoscopy procedures. Digestive tract endoscopy is a common procedure that takes place outside the operating room most of the time and has become more and more complex due to advanced invasive procedures. Prior evaluation of the patient's comorbidities and a good understanding of the objectives and constraints of the endoscopic procedures are required. Assessing the risk of gastric content aspiration is critical for determining appropriate anesthetic protocols. The availability of adequate monitoring (capnographs adapted to spontaneous ventilation, bispectral index), devices for administration of anesthetic/sedative agents (target-controlled infusion) and oxygenation (high flow nasal oxygenation) guarantees the quality of sedation and patient' safety during endoscopic procedures. Knowledge of the specificities of each interventional endoscopic procedure (endoscopic retrograde cholangiopancreatography, submucosal dissection) allows preventing complications during anesthesia.

Comparison of blind intubation with different supraglottic airway devices by inexperienced physicians in several airway scenarios: a manikin study

Endotracheal intubation is the gold standard for airway management. Supraglottic airway devices (SADs) are useful in airway abnormalities. SAD blind intubation enables airway management with better ventilation and a reduced risk of gastric content aspiration. The aim was to compare various SADs in blind intubation performed by inexperienced physicians in several pediatric airway scenarios. One hundred sixteen physicians with no previous experience with SAD performed blind endotracheal intubations with (1) iGEL, (2) Air-Q intubating laryngeal airway, and (3) Ambu AuraGain disposable laryngeal mask in a pediatric manikin in three airway scenarios: (A) normal airway without chest compressions, (B) normal airway with continuous chest compressions with the CORPULS CPR system, and (C) difficult airway with continuous chest compressions with the CORPULS CPR system. Intubation tube with 5.0 internal diameter was used for all blind intubation attempts. First intubation success rate, median time to SAD placement, time to endotracheal intubation with SAD, and ease to perform the intubation were investigated in this study. All these parameters were better or non-inferior for iGEL in all investigated scenarios.Conclusion: Our manikin study demonstrated that iGEL was the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios.What is Known:• For pediatric resuscitation, bag-mask ventilation is the first-line method for airway control and ventilation.• Endotracheal intubation is considered by many scientific societies the gold standard for airway management.• Supraglottic airway devices are particularly useful when bag-mask ventilation is difficult or impossible but can be also used for blind intubation.What is New:• The iGEL laryngeal mask turns out the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios.• It may be a reasonable first emergency blind intubation technique for inexperienced physicians in pediatric patients in normal airway with and without continuous chest compressions, as well as in difficult airway with continuous chest compressions.

Ultrasonographic Evaluation of Gastric Content During Labour Under Epidural Analgesia

Background Women in labour are considered at risk of gastric content aspiration partly because the stomach remains full before delivery. Ultrasonographic measurement of antral cross-sectional area (CSA) is a validated method of gastric content assessment. Our aim was to determine gastric content volume and its changes in parturients during labour under epidural analgesia using bedside ultrasonography. Methods The cut-off value corresponding to an increased gastric content was determined by ultrasound measurement of antral CSA in six pregnant women in late pregnancy before and after ingestion of 250 ml of non-clear liquid. Antral CSA was then measured twice in 60 parturients who presented in spontaneous labour: when the anaesthesiologist was called for epidural analgesia catheter placement, and at full cervical dilatation. Patient-controlled epidural analgesia was performed with a solution of ropivacaine and sufentanil. Results After liquid ingestion, antral CSA (mm 2 ) increased from 90 (range, 80–151) to 409 (range, 317–463). A CSA of 320 was taken as cut-off value. The feasibility rate of antral CSA determination was 96%. CSA decreased from 319 [Q1 158–Q3 469] to 203 [Q1 123–Q3 261] during labour ( P =2×10 −7 ). CSA was >320 in 50% of parturients at the beginning of labour vs 13% at full cervical dilatation ( P =0.006). Conclusions Bedside ultrasonographic antral CSA measurement is feasible in pregnant women during labour and easy to perform. The observed decrease in antral CSA during labour suggests that gastric motility is preserved under epidural anaesthesia. The procedure could be used to assess individual risk of gastric content aspiration during labour.

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

Women in labour are considered at risk of gastric content aspiration partly because the stomach remains full before delivery. Ultrasonographic measurement of antral cross-sectional area (CSA) is a validated method of gastric content assessment. Our aim was to determine gastric content volume and its changes in parturients during labour under epidural analgesia using bedside ultrasonography. The cut-off value corresponding to an increased gastric content was determined by ultrasound measurement of antral CSA in six pregnant women in late pregnancy before and after ingestion of 250 ml of non-clear liquid. Antral CSA was then measured twice in 60 parturients who presented in spontaneous labour: when the anaesthesiologist was called for epidural analgesia catheter placement, and at full cervical dilatation. Patient-controlled epidural analgesia was performed with a solution of ropivacaine and sufentanil. After liquid ingestion, antral CSA (mm(2)) increased from 90 (range, 80-151) to 409 (range, 317-463). A CSA of 320 was taken as cut-off value. The feasibility rate of antral CSA determination was 96%. CSA decreased from 319 [Q1 158-Q3 469] to 203 [Q1 123-Q3 261] during labour (P=2×10(-7)). CSA was >320 in 50% of parturients at the beginning of labour vs 13% at full cervical dilatation (P=0.006). Bedside ultrasonographic antral CSA measurement is feasible in pregnant women during labour and easy to perform. The observed decrease in antral CSA during labour suggests that gastric motility is preserved under epidural anaesthesia. The procedure could be used to assess individual risk of gastric content aspiration during labour.

Characteristics of Gastroesophageal Reflux and Potential Risk of Gastric Content Aspiration in Children With Cystic Fibrosis

Increased gastroesophageal reflux (GER) is common in children with cystic fibrosis (CF). We studied the occurrence of acid, weakly acidic (WA), and weakly alkaline (WALK) reflux in children with CF and evaluated a possible surrogate marker for risk of gastric content aspiration. Twenty-four children with CF underwent impedance-pH monitoring for detection of acid (pH < 4), WA (pH 4-7), and WALK-GER (pH > or = 7). In 11 children, cough was objectively recorded with esophageal manometry and the symptom association probability was calculated to determine the reflux-cough relation. Presence of bile acids (BA) was measured in the saliva of 65 patients with CF and 23 healthy children, respectively. Sixteen of the 24 children had increased GER (esophageal acid exposure). The majority of reflux events were acidic in nature. WA reflux was less common and WALK reflux was rare. The sequence reflux-cough was found in 8 of the 11 children and 1 of 11 children had a positive symptom association probability for reflux-cough. The sequence cough-reflux was found in only 3 of the 11 children. Only a small fraction of the total esophageal acid and volume exposure was secondary to cough. Twenty-three of the 65 children with CF had BA in saliva compared with none of the healthy controls. Although WA-GER is uncommon, acid GER is prevalent in children with CF. It is a primary phenomenon and is not secondary to cough. One third of the children with CF have BA in saliva, which may indicate an increased risk for aspiration. However, the impact of salivary BA and potential aspiration on CF pulmonary disease needs further investigation.

How Long a Fast Before Elective Surgery?

Anesthesiology| November 01 2003 How Long a Fast Before Elective Surgery? AAP Grand Rounds (2003) 10 (5): 58–59. https://doi.org/10.1542/gr.10-5-58 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation How Long a Fast Before Elective Surgery?. AAP Grand Rounds November 2003; 10 (5): 58–59. https://doi.org/10.1542/gr.10-5-58 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: surgical procedures, elective, fasting, pulmonary aspiration Source: Cook-Sather SD, Harris KA, Chiavacci R, et al. A liberalized fasting guideline for formula-fed infants does not increase average gastric fluid volume before elective surgery. Anesth Analg. 2003;96:965–969. This prospective, randomized, observer-blinded trial was undertaken at the Children’s Hospital of Philadelphia to determine whether infants’ gastric fluid volume was affected by a shorter period of pre-anesthetic fast from formula. Ninety-seven infants aged less than 10 months were enrolled during a 32-month period and randomized to 2 groups. The liberalized fasting group (mean age, 5.7 months) was allowed formula 4–6 hours prior to the induction of general anesthesia but no solids or cow’s milk within 8 hours of induction. The traditional group (mean age, 6.4 months) was allowed clear liquids 2–5 hours prior to the induction of general anesthesia and no solids, milk, or formula within 8 hours of induction. All subjects were American Society of Anesthesiology (ASA) physical status I or II and scheduled for elective surgical procedures which would require endotracheal intubation. Anesthesia was induced by inhalation of oxygen and nitrous oxide with either halothane or sevoflurane. Once intubated, gastric fluid was aspirated and the volume measured. The 2 groups did not differ with regard to age, weight, gender, or volume of last feed. As expected, based on the study design, the liberalized feeding group had an average fasting time of 5.4+/−0.7 hours versus 3.8+/−0.8 hours for the traditional group (P<.0005). No subject 0005). No subject P in this study had evidence of aspiration of gastric contents. The mean gastric fluid volume (GFV) and pH were not statistically different between the 2 groups. GFV was 0.16 ml/kg in the traditional group and 0.19 ml/kg in the liberalized group. Sixty-four percent of the infants fed by the traditional method and 55% of the liberalized feeding group had a GFV of zero. GFV did not correlate with fasting interval or with the volume of the last feeding. GFV did increase slightly with age. Parents’ response to a short survey of questions about their infant’s irritability and hunger as well as the parents’ satisfaction with the perioperative fasting period did not differ between the liberalized and traditional fasting groups. The authors note that their study was too small to demonstrate a change in the incidence of perioperative aspiration resulting from a change in fasting practice. A 0.01% incidence of pulmonary aspiration related to the induction of general anesthesia in pediatrics has been reported at a university-affiliated hospital.1 In another review of 56,000 patients younger than 18 years of age, an overall incidence of pulmonary aspiration of 0.04% was reported.2 It was noted in that review that the frequency of pulmonary aspiration did not differ across different age groups or ASA physical status classification.2 Pre-anesthesia fasting intervals reflect the tension between minimizing the risk of gastric content aspiration and assuring adequate hydration and patient comfort during the period of fasting. Fasting guidelines for infants and children have been modified frequently over... You do not currently have access to this content.