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Ultrasound assessment of the gastric content of women undergoing cesarean delivery during labor: a prospective descriptive study
Abstract Number: T-48
Abstract Type: Original Research
Background: Pulmonary aspiration of the gastric content is one of the most feared complications in obstetric anesthesia. Bedside gastric ultrasonography (US) is a feasible imaging tool that can be reliably performed by anesthesiologists to assess gastric content in the perioperative period.1,2 The aim of this study was to provide a qualitative and quantitative description of the sonographic appearance of the gastric antrum of women undergoing cesarean delivery during labor.
Methods: We conducted this prospective observational study in women undergoing cesarean delivery during labor. The assessment was performed on the operating table, immediately preceding surgery. A standardized scanning protocol of the gastric antrum was carried out using a 5-2 MHz curvilinear array transducer in a sagittal to right parasagittal plane on the epigastric area by one of three anesthesiologists trained in gastric ultrasound. Subjects were on a 450 semi-recumbent position, initially supine and then in right lateral decubitus (RLD). We performed a qualitative assessment of the gastric content and classified the subjects according to a 4-point grading system (grade 0: empty; grade 1: fluid seen in RLD only; grade 2: fluid seen in both positions; grade 3: any solid content). We also performed a quantitative assessment by measuring the cross-sectional area of the antrum (CSA) in both study positions. Primary outcome: qualitative assessment of the antrum (empty, fluids, solid contents) and antrum classification (grade 0-3). Secondary outcome: quantitative assessment (CSA of the antrum).
Results: We have examined 18 out of 60 planned subjects. Women had stopped ingestion of solids and clear fluids for 10.9 (6.1) hr and 3.3 (2.8) hr, respectively (mean (SD)). Qualitative assessment showed (n/N, %): grade 0 (4/18, 22.2%), grade 1 (6/18, 33.3%), grade 2 (3/18, 16.7%), grade 3 (5/18, 27.8%). Quantitative assessment of clear fluids showed a CSA mean (SD) of 5.1 (2.5) cm2 in the supine and 6.4 (2.6) cm2 in the RLD position.
Conclusion: A significant percentage of women presenting for cesarean delivery during labor will exhibit a gastric antrum sonogram compatible with a stomach that is empty or contain baseline physiological fluid volumes. A systematic qualitative/quantitative assessment of the gastric content may help anesthesiologists to better assess aspiration risk and guide anesthetic and airway management as part of the decision-making process in non-elective cesarean deliveries.
References: (1) Can J Anesth 2012;59:416; (2) Can J Anesth 2015;62:1188