Comparison of ultrasound measured gastric volume in term-pregnant patients posted for elective cesarean section with nonpregnant elective surgery patients---An observational study

IF 0.2 Q4 ANESTHESIOLOGY

Journal of Obstetric Anaesthesia and Critical Care Pub Date : 2023-01-01 DOI:10.4103/JOACC.JOACC_25_22

Snigdha Bellapukonda, S. Podder, Kamal Kajal, G. Prasad

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引用次数: 0

Abstract

Background: The pregnant patients undergoing anesthesia are at increased risk of aspiration due to decreased lower esophageal sphincter tone and mass effect of gravid uterus on gastric antrum. Ultrasound used as a noninvasive bedside imaging tool to measure gastric volume in term pregnant patients immediately before elective caesarian section (CS) may help in reducing aspiration induced morbidity and mortality. Methods: This observational prospective case--control study was conducted in 33 nonlaboring term pregnant patients immediately before elective CS and 30 nonpregnant patients immediately before elective surgeries, enrolled according to inclusion and exclusion criteria. A 2-5 MHz curvilinear probe was used to scan the participants in supine and right lateral decubitus (RLD) position in pre-recovery room. Visibility, qualitative grading (0,1, 2), anteroposterior (AP), and craniocaudal (CC) diameter, and cross-sectional area (CSA) of gastric antrum was measured. Gastric volume was derived from CSA using equations formulated by previous investigators. Results: Gastric antrum was visible in 27 (82%) of pregnant and 30 (100%) of nonpregnant patients in supine position (P = 0.014). In RLD position, 25 (75.7%) pregnant and 29 (96.7%) nonpregnant patients had antrum visible (P = 0.018). The qualitative grading was comparable (P = 0.064) in both the groups. In supine position, (P = 0.615), CSA in cm2 was 3.37 ± 1.31 and 3.54 ± 1.33, while in RLD position (P = 0.012), CSA was 3.98 ± 1.13 and 5.09 ± 1.85, in pregnant and nonpregnant patients, respectively. Conclusion: Gravid uterus sometimes impedes visualization of antrum by ultrasound in term pregnant patients immediately before elective CS and shows clinically similar gastric CSA when compared to nonpregnant patients, though statistically different in RLD position. Trial registration number- NCT03380637

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超声测量择期剖宫产和非妊娠期择期手术患者胃容量的比较——一项观察性研究

背景：由于食管下括约肌张力降低和妊娠子宫对胃窦的质量影响，接受麻醉的孕妇误吸的风险增加。超声作为一种非侵入性床边成像工具，在择期剖腹产（CS）前立即测量足月妊娠患者的胃容量，可能有助于降低抽吸引起的发病率和死亡率。方法：这项观察性前瞻性病例对照研究对33名择期CS前的非流产足月妊娠患者和30名择期手术前的非妊娠患者进行了研究，并根据纳入和排除标准进行了入选。在康复前室，使用2-5 MHz曲线探头对仰卧位和右侧卧位的参与者进行扫描。测量胃窦的可见度、定性分级（0,1,2）、前后径（AP）和头尾径（CC）以及横截面积（CSA）。胃容量是根据CSA使用先前研究人员制定的方程式得出的。结果：在仰卧位，27例（82%）孕妇和30例（100%）非孕妇可见胃窦（P=0.014）。在RLD位，25例（75.7%）孕妇和29例（96.7%）非孕妇胃窦可见（P=0.018）。两组的定性分级具有可比性（P=0.064）。在仰卧位（P=0.615），妊娠和非妊娠患者的CSA（cm2）分别为3.37±1.31和3.54±1.33，而在RLD位（P=0.012），CSA分别为3.98±1.13和5.09±1.85。结论：妊娠期患者在择期CS前，妊娠子宫有时会阻碍超声对胃窦的显示，与非妊娠期患者相比，妊娠子宫在临床上表现出相似的胃CSA，尽管RLD位置存在统计学差异。试验注册号-NCT03380637

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来源期刊

Journal of Obstetric Anaesthesia and Critical Care Multiple-

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审稿时长

29 weeks