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• W1971157961 abstract "Pulmonary aspiration of gastric content is a serious anaesthetic complication that can lead to significant morbidity and mortality. Aspiration risk assessment is usually based on fasting times. However, fasting guidelines do not apply to urgent or emergent situations and to patients with certain co-morbidities. Gastric content and volume assessment is a new point-of-care ultrasound application that can help determine aspiration risk. This systematic review summarizes the current literature on bedside ultrasound assessment of gastric content and volume relevant to anaesthesia practice. Seventeen articles were identified using predetermined criteria. Studies were classified into those describing the sonographic characteristics of different types of gastric content (empty, clear fluid, solid), and those describing methods for quantitative assessment of gastric volume. A possible algorithm for the clinical application of this new tool is proposed, and areas that require further research are highlighted. Pulmonary aspiration of gastric content is a serious anaesthetic complication that can lead to significant morbidity and mortality. Aspiration risk assessment is usually based on fasting times. However, fasting guidelines do not apply to urgent or emergent situations and to patients with certain co-morbidities. Gastric content and volume assessment is a new point-of-care ultrasound application that can help determine aspiration risk. This systematic review summarizes the current literature on bedside ultrasound assessment of gastric content and volume relevant to anaesthesia practice. Seventeen articles were identified using predetermined criteria. Studies were classified into those describing the sonographic characteristics of different types of gastric content (empty, clear fluid, solid), and those describing methods for quantitative assessment of gastric volume. A possible algorithm for the clinical application of this new tool is proposed, and areas that require further research are highlighted. Editor’s key points•The authors review the literature regarding the use of ultrasound to estimate gastric volume and, thus, aspiration risk.•Suggestions for clinical usage are provided. •The authors review the literature regarding the use of ultrasound to estimate gastric volume and, thus, aspiration risk.•Suggestions for clinical usage are provided. Perioperative aspiration of gastric contents is a rare but serious complication of anaesthesia. The overall incidence in a mixed surgical population ranges between <0.1% and 19% depending on patient and surgical factors and it has not changed in the last few decades.1Sakai T Planinsic RM Quinlan JJ Handley LJ Kim TY Hilmi IA The incidence and outcome of perioperative pulmonary aspiration in a university hospital: a 4-year retrospective analysis.Anesth Analg. 2006; 103: 941-947Crossref PubMed Scopus (117) Google Scholar, 2Neilipovitz DT Crosby ET No evidence for decreased incidence of aspiration after rapid sequence induction.Can J Anaesth. 2007; 54: 748-764Crossref PubMed Scopus (132) Google Scholar, 3Ng A Smith G Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice.Anesth Analg. 2001; 93: 494-513PubMed Google Scholar, 4Borland LM Sereika SM Woelfel SK et al.Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome.J Clin Anesth. 1998; 10: 95-102Abstract Full Text Full Text PDF PubMed Scopus (159) Google Scholar, 5Kozlow J Berenholtz S Garrett E Dorman T Pronovost P Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999–2000.Crit Care Med. 2003; 31: 1930-1937Crossref PubMed Scopus (82) Google Scholar Aspiration pneumonia is associated with significant morbidity, including prolonged mechanical ventilation,6Warner MA Warner ME Weber JG Clinical significance of pulmonary aspiration during the perioperative period.Anesthesiology. 1993; 78: 56-62Crossref PubMed Scopus (611) Google Scholar and carries a risk of mortality as great as 5%. Pulmonary aspiration is involved in up to 9% of all anaesthesia-related deaths.7Shime N Ono A Chihara E Tanaka Y Current status of pulmonary aspiration associated with general anesthesia: a nationwide survey in Japan.Masui. 2005; 54: 1177-1185PubMed Google Scholar 8Lienhart A Auroy Y Pequignot F et al.Survey of anesthesia related mortality in France.Anesthesiology. 2006; 105: 1087-1097Crossref PubMed Scopus (437) Google Scholar One of the main risk factors for aspiration is the presence of gastric content. The critical volume threshold of gastric fluid that by itself increases aspiration risk is controversial, but healthy, fasted patients frequently have residual gastric volumes (GVs) of up to 1.5 ml kg−1 without significant aspiration risk.9Agarwal A Chari P Singh H Fluid deprivation before operation: the effect of a small drink.Anesthesia. 1989; 44: 632-634Crossref PubMed Scopus (100) Google Scholar, 10Read MS Vaughan RS Allowing pre-operative patients to drink: effects on patients’ safety and comfort of unlimited oral water until 2 hours before anaesthesia.Acta Anaesthesiol Scand. 1991; 35: 591-595Crossref PubMed Scopus (94) Google Scholar, 11Phillips S Hutchinson S Davidson T Preoperative drinking does not affect gastric contents.Br J Anaesth. 1993; 70: 6-9Abstract Full Text PDF PubMed Scopus (180) Google Scholar, 12Harter R Kelly W Kramer M Perz C Dzwonczyk R A comparison of the volume and pH of gastric contents of obese and lean surgical patients.Anesth Analg. 1998; 86: 147-152PubMed Google Scholar, 13Hausel J Nygren J Lagerkranser M et al.A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients.Anesth Analg. 2001; 93: 1344-1350Crossref PubMed Scopus (378) Google Scholar Sedation and general anaesthesia depress or impede the physiological mechanisms that protect against aspiration (the tone of the lower oesophageal sphincter and upper airway reflexes).14Cotton BR Smith G The lower oesophageal sphincter and anaesthesia.Br J Anaesth. 1984; 56: 37-46Abstract Full Text PDF PubMed Scopus (104) Google Scholar 15Vanner RG Pryle BJ O’Dwyer JP Reynolds F Upper oesophageal sphincter pressure and the intravenous induction of anesthesia.Anaesthesia. 1992; 47: 371-375Crossref PubMed Scopus (58) Google Scholar Since restriction of fluid and food intake before general anaesthesia is vital for patient safety, anaesthesiology societies have developed guidelines for preoperative fasting.16Smith I Kranke P Murat I et al.European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.Eur J Anaesthesiol. 2011; 28: 556-569Crossref PubMed Scopus (542) Google Scholar 17American Society of AnaesthesiologistsPractice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures.Anesthesiology. 2011; 114: 495-511Crossref PubMed Scopus (624) Google Scholar For example, current guidelines by the ASA recommend a minimum of 2 h of fasting for clear fluids, 6 h after a light meal (toast and clear fluids), and 8 h after a full meal with high calorie or fat content.17American Society of AnaesthesiologistsPractice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures.Anesthesiology. 2011; 114: 495-511Crossref PubMed Scopus (624) Google Scholar However, these guidelines apply only to healthy patients for elective surgery and are not reliable in patients with coexisting diseases that affect gastric emptying or volume, patients in whom airway management might be difficult or in emergency situations.17American Society of AnaesthesiologistsPractice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures.Anesthesiology. 2011; 114: 495-511Crossref PubMed Scopus (624) Google Scholar This systematic review summarizes the current state of knowledge on the use of bedside ultrasound to evaluate gastric content and volume as they relate to aspiration risk assessment from the perspective of the clinical anaesthesiologist. The recommendations and checklist of the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) were followed to conduct and report this review.18Moher D Liberati A Tetzlaff J Altman DG PRISMA GroupPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Ann Intern Med. 2009; 151: 264-269Crossref PubMed Scopus (17349) Google Scholar The National Library of Medicine’s PubMed, OVID Medline, and EMBASE databases were searched since their date of inception to February 2013 using the following Medical Subject Headings: gastric ultrasonography or gastric ultrasound or gastric sonography and stomach or antrum were used. The search was restricted to English language articles and human subjects. Two independent reviewers read all citations. Prospective or retrospective experimental studies of portable 2D ultrasonography on human subjects, case series, or observational studies were selected for inclusion if they addressed one or two of the following questions: (i) Can ultrasound determine the nature of gastric content (empty, clear fluid, or thick fluid/solid)?, (ii) Can ultrasound estimate the volume of gastric fluid?, or both. Commentaries, abstracts, letters to the editor, case reports, editorials, and meeting proceedings were excluded. Discrepancies were settled by discussion and consensus. Selected articles underwent full-text review and references were screened for further articles not identified by the searches. The following data were extracted from each included study: publication year, country of origin, study design, number of subjects and patient characteristics, gastric sections studied (antrum, body, fundus), scanning position, and plane. For quantitative studies, details of mathematical models were extracted (reference standard, correlation coefficient). Three hundred and ninety-four citations were identified (Fig. 1). Based on title and abstract, 356 were excluded as not meeting inclusion criteria, and five were duplicates. Thirty-three articles were retrieved for full-text review. Of these, 22 publications were excluded (13 studied gastric emptying, three studied gastric motility, and six were on other gastroenterology applications not directly related to aspiration risk assessment). Six additional articles were identified from reference lists. Seventeen articles were included in this review. Eight articles dealt with qualitative assessment (Table 1), seven articles dealt with quantitative assessment (Table 2), and two additional studies were included in both categories. Of the included studies, 41% (n=7) were published before 2000, 18% (n=3) between 2000 and 2009, and the remaining 41% (n=7) in or after 2010. The majority of the studies originated in North America (47%, n=8) and Europe (41%, n=7), whereas 12% (n=2) were from Japan. A total of 533 subjects were included in the qualitative studies and 542 subjects in the quantitative studies. Study populations consisted of healthy volunteers (n=267), pregnant patients (n=73), newborns (n=32), other paediatric patients (n=16), elective adult surgical subjects (n=467), upper gastric endoscopy (n=140), or intensive care patients (n=80). The antrum was evaluated in 82% of the studies, the fundus in 23%, and the gastric body in 35%. Two studies did not specify which section of the stomach was evaluated.Table 1Qualitative studies. *, mean (sd); and °, rangeAuthorYearCountryDesignStudy populationnAge (yr)BMIPatient positionGastric sectionScanning planeEmptyFluidSolidSijbrandij and Op den Orth19Sijbrandij LS Op den Orth JO Transabdominal ultrasound of the stomach: a pictorial essay.Eur J Radiol. 1991; 13: 81-87Abstract Full Text PDF PubMed Scopus (14) Google Scholar1991The NetherlandsPictorial essayNANANANARLDA/F/BOblique left upper quadrantNoYesNoCarp and colleagues20Carp H Jayaram A Stoll M Ultrasound examination of the stomach contents of parturients.Anesth Analg. 1992; 74: 683-687Crossref PubMed Scopus (100) Google Scholar1992USAOBSFemales (OB and non-OB)93NRNRSIT/RLDA/BOblique left upper quadrantNoYesYesJayaram and colleagues21Jayaram A Bowen MP Deshpande S Carp HM Ultrasound examination of the stomach contents of women in the postpartum period.Anesth Analg. 1997; 84: 522-526Crossref PubMed Google Scholar1997USAOBSFemales (OB and non-OB)9420–40°20–40°SITA/BOblique left upper quadrantNoYesYesJacobyand colleagues22Jacoby J Smith G Eberhardt M Heller M Bedside ultrasound to determine prandial status.Am J Emerg Med. 2003; 21: 216-219Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar2003USAINT blindVolunteers20NRNRSUP/RLDNRAxialNoYesYesPerlas and colleagues23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar2009CanadaOBSVolunteers18NRNRSUP/RLDA/B/FParasagittalYesYesYesBouvet and colleagues24Bouvet L Miquel A Chassard D Boselli E Allaouiche B Benhamou D Could a single standardized ultrasound measurement of antral area be of interest for assessing gastric contents? A preliminary report.Eur J Anesthesiol. 2009; 26: 1015-1019Crossref PubMed Scopus (77) Google Scholar2009FranceINT blindVolunteers2227–51°21–24°Semi SITANRYesYesYesSporea and Popescu25Sporea I Popescu A Ultrasound examination of the normal gastrointestinal tract.Med Ultrason. 2010; 12: 349-352PubMed Google Scholar2010RomaniaTechnical reportNANANANANAA/B/FAxial/sagittalYesYesNoKoenigand colleagues26Koenig SJ Lakticova V Mayo PH Utility of ultrasonography for detection of gastric fluid during urgent endotracheal intubation.Intensive Care Med. 2011; 37: 627-631Crossref PubMed Scopus (45) Google Scholar2011USAOBSICU patients for urgent intubation8020–91°NRSUPB/FAxial/mid-axillary lineYesYesYesPerlas and colleagues27Perlas A Davis L Khan M Mitsakakis N Chan VW Gastric sonography in the fasted surgical patient: a prospective descriptive study.Anesth Analg. 2011; 113: 93-97Crossref PubMed Scopus (174) Google Scholar2011CanadaOBSAdult surgical patients20051 (16)*28 (5)*SUP/RLDASagittalYesYesNoCubillos and colleagues28Cubillos J Tse C Chan VW Perlas A Bedside ultrasound assessment of gastric content: an observational study.Can J Anaesth. 2012; 59: 416-423Crossref PubMed Scopus (96) Google Scholar2012CanadaPictorial essayVolunteers634 (7)*27 (2)*RLDAAxial/sagittalYesYesYes Open table in a new tab Table 2Sonographic presentation of the antrum and contentsEmptyClear fluidMilk or suspensionsSolidAntral shapeFlat, collapsed, or round (bull’s eye)Round, distendedRound, distendedRound, distendedAntral wallThick, prominent muscularis propriaeThinThinThinContentNone (grade 0) or small amount of hypoechoic content (grade 1)HypoechoicHyperechoicHyperechoicHeterogeneous (mixed with air)PeristalsisNonePresent (usually fast waves)PresentPresent (usually slow waves) Open table in a new tab Ten articles describe the utility of ultrasound to determine the nature of the gastric content (Table 1). The stomach has been imaged with the patient in the supine, sitting, semi-sitting, or right lateral decubitus (RLD) position. The best position depends on the section of the stomach to be imaged and affects sonographic findings. Several studies suggest that the distal parts of the stomach (antrum and body) are better evaluated in a semi-sitting or RLD position.19Sijbrandij LS Op den Orth JO Transabdominal ultrasound of the stomach: a pictorial essay.Eur J Radiol. 1991; 13: 81-87Abstract Full Text PDF PubMed Scopus (14) Google Scholar, 20Carp H Jayaram A Stoll M Ultrasound examination of the stomach contents of parturients.Anesth Analg. 1992; 74: 683-687Crossref PubMed Scopus (100) Google Scholar, 21Jayaram A Bowen MP Deshpande S Carp HM Ultrasound examination of the stomach contents of women in the postpartum period.Anesth Analg. 1997; 84: 522-526Crossref PubMed Google Scholar, 22Jacoby J Smith G Eberhardt M Heller M Bedside ultrasound to determine prandial status.Am J Emerg Med. 2003; 21: 216-219Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar 27Perlas A Davis L Khan M Mitsakakis N Chan VW Gastric sonography in the fasted surgical patient: a prospective descriptive study.Anesth Analg. 2011; 113: 93-97Crossref PubMed Scopus (174) Google Scholar, 28Cubillos J Tse C Chan VW Perlas A Bedside ultrasound assessment of gastric content: an observational study.Can J Anaesth. 2012; 59: 416-423Crossref PubMed Scopus (96) Google Scholar, 29Fujigaki T Fukusaki M Nakamura H Shibata O Sumikawa K Quantitative evaluation of gastric contents using ultrasound.J Clin Anesth. 1993; 5: 451-455Abstract Full Text PDF PubMed Scopus (24) Google Scholar Owing to a gravitational shift, a greater proportion of gastric content will move towards the more dependent areas of the stomach in these two positions. This may be especially important to evaluate gastric content in low-volume states in which gastric fluid may only be visible in a sitting or RLD position.20Carp H Jayaram A Stoll M Ultrasound examination of the stomach contents of parturients.Anesth Analg. 1992; 74: 683-687Crossref PubMed Scopus (100) Google Scholar 23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar 27Perlas A Davis L Khan M Mitsakakis N Chan VW Gastric sonography in the fasted surgical patient: a prospective descriptive study.Anesth Analg. 2011; 113: 93-97Crossref PubMed Scopus (174) Google Scholar Scanning technique was similar among different reports whether they studied healthy volunteers or patients. The only exception is a report on critically ill patients in which it may not be feasible to scan in a patient position other than supine.26Koenig SJ Lakticova V Mayo PH Utility of ultrasonography for detection of gastric fluid during urgent endotracheal intubation.Intensive Care Med. 2011; 37: 627-631Crossref PubMed Scopus (45) Google Scholar A curved array low-frequency transducer (2–5 MHz) with standard abdominal settings is most useful in adults. It provides the necessary penetration to identify the relevant anatomic landmarks.19Sijbrandij LS Op den Orth JO Transabdominal ultrasound of the stomach: a pictorial essay.Eur J Radiol. 1991; 13: 81-87Abstract Full Text PDF PubMed Scopus (14) Google Scholar A linear high-frequency transducer can be used in leaner or paediatric patients or to obtain detailed images of the gastric wall. The gastric wall is 4–6 mm thick and has a characteristic appearance of five distinct sonographic layers that are best visualized with a high-frequency transducer (e.g. 5–12 MHz) in the fasting state.19Sijbrandij LS Op den Orth JO Transabdominal ultrasound of the stomach: a pictorial essay.Eur J Radiol. 1991; 13: 81-87Abstract Full Text PDF PubMed Scopus (14) Google Scholar 25Sporea I Popescu A Ultrasound examination of the normal gastrointestinal tract.Med Ultrason. 2010; 12: 349-352PubMed Google Scholar 27Perlas A Davis L Khan M Mitsakakis N Chan VW Gastric sonography in the fasted surgical patient: a prospective descriptive study.Anesth Analg. 2011; 113: 93-97Crossref PubMed Scopus (174) Google Scholar 28Cubillos J Tse C Chan VW Perlas A Bedside ultrasound assessment of gastric content: an observational study.Can J Anaesth. 2012; 59: 416-423Crossref PubMed Scopus (96) Google Scholar These layers help differentiate the stomach from other hollow viscus. Starting at the inner surface of the stomach, the first thin hyperechoic layer corresponds to the mucosal–air interface. A second hypoechoic layer is the muscularis mucosa. A third hyperechoic layer corresponds to the submucosa. A fourth hypoechoic layer is most prominent and corresponds to the muscularis propria, whereas a fifth thin hyperechoic layer is the serosa.19Sijbrandij LS Op den Orth JO Transabdominal ultrasound of the stomach: a pictorial essay.Eur J Radiol. 1991; 13: 81-87Abstract Full Text PDF PubMed Scopus (14) Google Scholar 25Sporea I Popescu A Ultrasound examination of the normal gastrointestinal tract.Med Ultrason. 2010; 12: 349-352PubMed Google Scholar 27Perlas A Davis L Khan M Mitsakakis N Chan VW Gastric sonography in the fasted surgical patient: a prospective descriptive study.Anesth Analg. 2011; 113: 93-97Crossref PubMed Scopus (174) Google Scholar 28Cubillos J Tse C Chan VW Perlas A Bedside ultrasound assessment of gastric content: an observational study.Can J Anaesth. 2012; 59: 416-423Crossref PubMed Scopus (96) Google Scholar Several studies suggest that the antrum is the gastric region that is most amenable to sonographic examination.19Sijbrandij LS Op den Orth JO Transabdominal ultrasound of the stomach: a pictorial essay.Eur J Radiol. 1991; 13: 81-87Abstract Full Text PDF PubMed Scopus (14) Google Scholar 23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar 25Sporea I Popescu A Ultrasound examination of the normal gastrointestinal tract.Med Ultrason. 2010; 12: 349-352PubMed Google Scholar, 26Koenig SJ Lakticova V Mayo PH Utility of ultrasonography for detection of gastric fluid during urgent endotracheal intubation.Intensive Care Med. 2011; 37: 627-631Crossref PubMed Scopus (45) Google Scholar, 27Perlas A Davis L Khan M Mitsakakis N Chan VW Gastric sonography in the fasted surgical patient: a prospective descriptive study.Anesth Analg. 2011; 113: 93-97Crossref PubMed Scopus (174) Google Scholar–29Fujigaki T Fukusaki M Nakamura H Shibata O Sumikawa K Quantitative evaluation of gastric contents using ultrasound.J Clin Anesth. 1993; 5: 451-455Abstract Full Text PDF PubMed Scopus (24) Google Scholar It is the gastric portion most consistently identified (98–100% of cases).23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar 24Bouvet L Miquel A Chassard D Boselli E Allaouiche B Benhamou D Could a single standardized ultrasound measurement of antral area be of interest for assessing gastric contents? A preliminary report.Eur J Anesthesiol. 2009; 26: 1015-1019Crossref PubMed Scopus (77) Google Scholar 30Bouvet L Mazoit JX Chassard D Allaouchiche B Boselli E Benhamou D Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume.Anesthesiology. 2011; 114: 1086-1092Crossref PubMed Scopus (186) Google Scholar It is found superficially between the left lobe of the liver anteriorly and the pancreas posteriorly in a sagittal or para-sagittal scanning plane in the epigastrium.22Jacoby J Smith G Eberhardt M Heller M Bedside ultrasound to determine prandial status.Am J Emerg Med. 2003; 21: 216-219Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar, 24Bouvet L Miquel A Chassard D Boselli E Allaouiche B Benhamou D Could a single standardized ultrasound measurement of antral area be of interest for assessing gastric contents? A preliminary report.Eur J Anesthesiol. 2009; 26: 1015-1019Crossref PubMed Scopus (77) Google Scholar, 25Sporea I Popescu A Ultrasound examination of the normal gastrointestinal tract.Med Ultrason. 2010; 12: 349-352PubMed Google Scholar 27Perlas A Davis L Khan M Mitsakakis N Chan VW Gastric sonography in the fasted surgical patient: a prospective descriptive study.Anesth Analg. 2011; 113: 93-97Crossref PubMed Scopus (174) Google Scholar 28Cubillos J Tse C Chan VW Perlas A Bedside ultrasound assessment of gastric content: an observational study.Can J Anaesth. 2012; 59: 416-423Crossref PubMed Scopus (96) Google Scholar 31Perlas A Mitsakakis N Liu L et al.Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination.Anesth Analg. 2013; 116: 357-363Crossref PubMed Scopus (202) Google Scholar Important vascular landmarks including both the aorta or inferior vena cava (IVC) and either the superior mesenteric artery or vein have been used to standardize a scanning plane through the antrum.22Jacoby J Smith G Eberhardt M Heller M Bedside ultrasound to determine prandial status.Am J Emerg Med. 2003; 21: 216-219Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar, 24Bouvet L Miquel A Chassard D Boselli E Allaouiche B Benhamou D Could a single standardized ultrasound measurement of antral area be of interest for assessing gastric contents? A preliminary report.Eur J Anesthesiol. 2009; 26: 1015-1019Crossref PubMed Scopus (77) Google Scholar 27Perlas A Davis L Khan M Mitsakakis N Chan VW Gastric sonography in the fasted surgical patient: a prospective descriptive study.Anesth Analg. 2011; 113: 93-97Crossref PubMed Scopus (174) Google Scholar 28Cubillos J Tse C Chan VW Perlas A Bedside ultrasound assessment of gastric content: an observational study.Can J Anaesth. 2012; 59: 416-423Crossref PubMed Scopus (96) Google Scholar Not only is the antrum highly amenable to ultrasound imaging, its evaluation accurately reflects the content of the entire organ. The body of the stomach may be imaged by sliding the transducer towards the left subcostal margin using an oblique scanning plane.19Sijbrandij LS Op den Orth JO Transabdominal ultrasound of the stomach: a pictorial essay.Eur J Radiol. 1991; 13: 81-87Abstract Full Text PDF PubMed Scopus (14) Google Scholar, 20Carp H Jayaram A Stoll M Ultrasound examination of the stomach contents of parturients.Anesth Analg. 1992; 74: 683-687Crossref PubMed Scopus (100) Google Scholar, 21Jayaram A Bowen MP Deshpande S Carp HM Ultrasound examination of the stomach contents of women in the postpartum period.Anesth Analg. 1997; 84: 522-526Crossref PubMed Google Scholar 23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar 25Sporea I Popescu A Ultrasound examination of the normal gastrointestinal tract.Med Ultrason. 2010; 12: 349-352PubMed Google Scholar 26Koenig SJ Lakticova V Mayo PH Utility of ultrasonography for detection of gastric fluid during urgent endotracheal intubation.Intensive Care Med. 2011; 37: 627-631Crossref PubMed Scopus (45) Google Scholar In this plane, the anterior wall is consistently identified, extending from the lesser to the greater curvature.23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar However, the presence of air in the body frequently obscures the posterior wall, and it may be more difficult to image a full cross-section of the gastric body. The fundus is located in the left upper quadrant of the abdomen, inferior to the diaphragm, anterior to the left kidney, and posterior to the spleen. It is the most challenging section of the stomach to image due to its deep location and the lack of a wide acoustic window due to the rib cage. Two different approaches have been described. A left lateral, intercostal, trans-splenic approach has been reported with limited success.23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar 25Sporea I Popescu A Ultrasound examination of the normal gastrointestinal tract.Med Ultrason. 2010; 12: 349-352PubMed Google Scholar Alternatively, a longitudinal scan in the mid-axillary line has been used.26Koenig SJ Lakticova V Mayo PH Utility of ultrasonography for detection of gastric fluid during urgent endotracheal intubation.Intensive Care Med. 2011; 37: 627-631Crossref PubMed Scopus (45) Google Scholar Air is commonly found in both the fundus and the body, even in ‘empty’ stomachs, which hinders visualization of these two sections.19Sijbrandij LS Op den Orth JO Transabdominal ultrasound of the stomach: a pictorial essay.Eur J Radiol. 1991; 13: 81-87Abstract Full Text PDF PubMed Scopus (14) Google Scholar 23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82-89Crossref PubMed Scopus (229) Google Scholar An early study of gastric ultrasound in the anaesthesia literature differentiated between liquid and solid gastric contents.20Carp H Jayaram A Stoll M Ultrasound examination of the stomach contents of parturients.Anesth Analg. 1992; 74: 683-687Crossref PubMed Scopus (100) Google Scholar In this patient series, the stomach could only be identified in 60% of patients and could not be located when empty. However, more recent studies using contemporary technology report consistent success in identifying the stomach, especially the gastric antrum, even in the empty state.23Perlas A Chan VW Lupu CM Mitsakakis N Hanbidge A Ultrasound assessment of gastric content and volume.Anesthesiology. 2009; 111: 82" @default.
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• W1971157961 title "Ultrasound assessment of gastric content and volume" @default.
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