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Gastric ultrasonography in the fasted term pregnant women scheduled for elective Cesarean delivery: a prospective descriptive study
Abstract Number: T-30
Abstract Type: Original Research
Introduction: Pulmonary aspiration of gastric content is one of the most feared complications in obstetric anesthesia. Bedside gastric ultrasonography (US) can be reliably performed by anesthesiologists  to assess gastric content in the perioperative period, and may be useful in risk assessment and clinical management. We aimed to describe the qualitative and quantitative US assessment of the gastric antrum in fasted pregnant women.
Methods: Prospective, descriptive study in non-laboring pregnant women at term scheduled for elective cesarean delivery. Subjects were examined after a minimum period of overnight fasting (solid food-8 hrs; clear fluids-2 hrs) and prior to the cesarean delivery. Two anesthesiologists performed a standardized scanning protocol of the gastric antrum: subjects on a 45-degree semi-recumbent position, first supine and then in the right lateral decubitus (RLD), using a 2-5 MHz curvilinear array transducer in a sagittal to right parasagittal plane on the epigastric area. Based on the qualitative assessment of the antrum, subjects were classified following a 3-point grading system : grade 0, the antrum appears empty; grade 1, small fluid volume only seen in RLD suggesting residual gastric secretions; and grade 2: larger fluid volume seen both in supine and RLD. In addition, quantitative assessment was performed using 3 still images of the antrum at rest (between peristaltic contractions) in RLD to measure the cross-sectional area (CSA) with aid of the built-in caliper.
Results: We have recruited 40 of the 110 planed subjects. Age, height, weight, BMI, and gestational age: mean (SD) of 35.6(5) years, 163.1(8.2) cm, 79.1(15.3) kg, and 29.6(4.7) kg/m2, 38.6(0.9) weeks. Fasting period for solid food and clear fluids: median (IQR) of 13(3) and 3.75(6.5) hours. Qualitative assessment: grade 0 (18/40,45%), grade 1 (22/40, 55%), and grade 2 (0%). Quantitative assessment, mean (SD) [min-max] of CSA in RLD: 4.71 (2.1) [1.8-9.7] cm2. The qualitative grading system showed significant differences for the CSA in RLD: grade 0= 3.11 (0.8) cm2; and grade 1=6.09 (1.8) cm2; p-value<0.0001. There was no correlation between hours of fasting and CSA or qualitative grade.
Discussion: All women in our study presented with antral CSA compatible with residual gastric fluid. Furthermore, applying the predictive model obtained in non-pregnant population, our subjects presented with gastric volumes no greater than 110 ml. The qualitative 3-point grading system may be used to assess individual risk of perioperative gastric content aspiration. The quantitative measurement of antral CSA is a promising tool for predicting gastric fluid volume.
 Can J Anesth 2013; 60: 771–779
 Anesth Analg 2011; 113: 93–97
 Br J Anaesth 2014, Jan 8.
 Anesth Analg 2013; 116: 357–363.