Pre‐operative gastric ultrasound in patients at risk of pulmonary aspiration: a prospective observational cohort study

Abstract

SummaryPoint‐of‐care gastric sonography offers an objective approach to assessing individual pulmonary aspiration risk before induction of general anaesthesia. We aimed to evaluate the potential impact of routine pre‐operative gastric ultrasound on peri‐operative management in a cohort of adult patients undergoing elective or emergency surgery at a single centre. According to pre‐operative gastric ultrasound results, patients were classified as low risk (empty, gastric fluid volume ≤ 1.5 ml.kg‐1 body weight) or high risk (solid, mixed or gastric fluid volume > 1.5 ml.kg‐1 body weight) of aspiration. After sonography, examiners were asked to indicate changes in aspiration risk management (none; more conservative; more liberal) to their pre‐defined anaesthetic plan and to adapt it if patient safety was at risk. We included 2003 patients, 1246 (62%) of which underwent elective and 757 (38%) emergency surgery. Among patients who underwent elective surgery, 1046/1246 (84%) had a low‐risk and 178/1246 (14%) a high‐risk stomach, with this being 587/757 (78%) vs. 158/757 (21%) among patients undergoing emergency surgery, respectively. Routine pre‐operative gastric sonography enabled changes in anaesthetic management in 379/2003 (19%) of patients, with these being a more liberal approach in 303/2003 (15%). In patients undergoing elective surgery, pre‐operative gastric sonography would have allowed a more liberal approach in 170/1246 (14%) and made a more conservative approach indicated in 52/1246 (4%), whereas in patients undergoing emergency surgery, 133/757 (18%) would have been managed more liberally and 24/757 (3%) more conservatively. We showed that pre‐operative gastric ultrasound helps to identify high‐ and low‐risk situations in patients at risk of aspiration and adds useful information to peri‐operative management. Our data suggest that routine use of pre‐operative gastric ultrasound may improve individualised care and potentially impact patient safety.