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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 Nov 17

DOI: 10.23736/S0375-9393.17.12305-9


language: English

Gastric ultrasound to guide anesthetic management in elective surgical patients non-compliant with fasting instructions. A retrospective cohort study

Peter van de PUTTE 1, 2 , Jonathan van HOONACKER 1, Anahi PERLAS 3

1 Department of Anesthesiology, AZ Monica, Campus Deurne, Deurne, Belgium, 2 UMC Radboud, Nijmegen, The Netherlands; 3 Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada


BACKGROUND: Perioperative aspiration leads to significant morbidity and mortality. Standard fasting periods are used to ensure an empty stomach in patients. Anesthesiologists are frequently confronted with cases of dubious adherence to these guidelines. Point-of-care gastric ultrasound is a diagnostic tool that offers information on the type and volume of gastric contents.
METHODS: We performed a retrospective analysis of a departmental database containing clinical and sonographic information on elective surgical patients who had been non- compliant to the fasting guidelines. Primary outcome was the incidence of changes in aspiration risk stratification and anesthetic management when a point-of-care gastric ultrasound examination was added to a standard history-based clinical assessment. Secondary outcomes included a) types of changes (timing of the surgical procedure or change in anesthetic technique) b) the incidence of aspiration. Differences in the management plan (history-based versus gastric ultrasound) were tested with McNemar-Bowker’s exact test of symmetry.
RESULTS: Thirty-seven patients met the inclusion criteria. Aspiration risk assessment and anesthetic management changed in 24 cases (64.9 %) following gastric ultrasound. Additionally, there was a non-significant difference in the distribution of the pre- and posttest changes in timing (delay, cancel, proceed)(p=0.074) with a trend towards a lower number of surgical cancellations and a higher number of proceeds. No aspirations were documented.
CONCLUSIONS: This retrospective study suggests that gastric ultrasound may be a useful diagnostic addition to standard patient assessment in cases of non-compliance to fasting guidelines. It allows to personalize aspiration risk assessment and to tailor anesthetic management to the individual patient.

KEY WORDS: NPO guidelines - Stomach contents - Gastric - Ultrasound - Patient non-compliance

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Publication History

Article first published online: November 17, 2017
Manuscript accepted: November 14, 2017
Manuscript revised: October 20, 2017
Manuscript received: July 17, 2017

Cite this article as

van de Putte P, van Hoonacker J, Perlas A. Gastric ultrasound to guide anesthetic management in elective surgical patients non-compliant with fasting instructions. A retrospective cohort study. Minerva Anestesiol 2017 Nov 17. DOI: 10.23736/S0375-9393.17.12305-9

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