Ultrasound assessment of gastric contents in emergency patients examined in the full supine position: an appropriate com
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EDITORIAL
Ultrasound assessment of gastric contents in emergency patients examined in the full supine position: an appropriate composite ultrasound grading scale can finally be proposed Lionel Bouvet1 · Dominique Chassard1 Received: 11 December 2019 / Accepted: 17 December 2019 © Springer Nature B.V. 2019
Point-of-care ultrasonography allows bedside ultrasoundguided management of clinical issues such as acute respiratory and hemodynamic failures [1], undifferentiated shocks or shocks related to trauma using FAST ultrasound [2, 3]. Thus, it has become a major diagnosis and assessment tool available to the anesthesiologist facing critical situations in the operating room or in critical care unit. Pulmonary aspiration of gastric contents remains one of the leading causes of mortality and morbidity related to anesthesia; consequently, every patient should be assessed for the risk of aspiration prior to anesthesia [4]. Some risk factors for regurgitation and aspiration are well known by the anesthesiologists, especially those related to lower esophageal sphincter failure or to the increase in gastric content volume due to gastrointestinal obstruction. Nevertheless, in many circumstances, clinical assessment of the risk of aspiration remains difficult and uncertain. In particular, the minimal fasting duration ensuring low risk of aspiration in emergency patients remains unclear, leading the ASA guidelines to state that current fasting guidelines do not apply to emergency patients [5]. In fact, gastric content status depends on several factors, including the type and amount of food, the caloric value of the last meal, preexisting gastroparesis, the administration of some analgesic drugs delaying gastric emptying during the preoperative period, the level of preoperative pain and stress affecting gastric emptying. Therefore, point-of-care gastric ultrasound has become a useful tool for the preoperative assessment of gastric content and volume, helping the anesthesiologist to assess the
* Lionel Bouvet lionel.bouvet@chu‑lyon.fr 1
Department of Anesthesiology and Intensive Care, Femme-Mère-Enfant Hospital, Groupement Hospitalier Est, Hospices Civils de Lyon, 59 boulevard Pinel, Bron, 69500 Lyon, France
risk of regurgitation and aspiration, in addition to the clinical assessment of the risk of aspiration. Gastric ultrasound, actually antral ultrasound, was first described for the determination of gastric emptying of a test meal in patients suffering from gastrointestinal diseases. This technique implies repeated measurements of the antral cross-sectional area to calculate gastric emptying rate that highly correlates to the rate provided by gastric scintigraphy [6]. On the other hand, preoperative ultrasound diagnosis of gastric content status can only be based on the appropriate and careful interpretation of a single real-time ultrasound examination of the antrum. The reliability of gastric ultrasound for the preoperative assessment of gastric contents and volume has been the subject of several studies published these
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