Preoperative Ultrasonographic Assessment of Gastric Volume and Fasting Hours

Not yet recruiting

Conditions: Measurement and Monitoring,

Registration Number: CTRI/2020/03/024005

Lead Sponsor: Dr Sunil N Bodamwad

Brief Summary: Perioperative pulmonary aspiration of gastric contents is a serious complication of anaesthesia and is associated with high morbidity and mortality. It can result in severe pneumonia requiring mechanical ventilator support in up to one-third of patients with a mortality of 5%, representing up to 9% of all anaesthesia-related deaths. The severity of the resulting respiratory compromise is thought to be related to both the volume and nature of the aspirate, with particulate matter carrying the highest risk. Preoperative fasting guidelines help limit the risk in elective patients with minimal co-morbidities. However, fasting intervals are not applicable or reliable in urgent or emergency surgeries or for patients with certain medical conditions. 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 without significant aspiration risk.

In anaesthesiology and acute care medicine, there is a growing interest in bedside evaluation of gastric â€˜fullnessâ€™ to assess pulmonary aspiration risk. With the advent of portable ultrasound machines, performing point-of-care ultrasound has become relatively easy and feasible. Gastric ultrasound examination is finding a place as a point-of-care tool for aspiration risk assessment. It can identify the nature of the gastric content, i.e. empty, clear fluid and solid and when clear fluid is present, its volume can be quantified.

The objective is to determine the correlation between fasting times and gastric content and estimated gastric volume in patients presenting for elective surgery and also to see if the gastric contents and gastric volume are any different in patients with conditions which supposedly predispose them to delayed gastric emptying like diabetes, chronic kidney disease and obesity compared to those without such conditions.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 110

Inclusion Criteria

Patients aged between 18 and 80 years posted for elective surgery who will be fasted for more than 6 hours for solids and more than 2 hours for clear fluids but not more than 16 hours will be identified in the ward.
Such patients giving consent for performing preoperative gastric ultrasound will be included in our study.

Exclusion Criteria

1.Pregnant women.
2.Patients with unreliable or unclear fasting history (e.g. language barrier, cognitive dysfunction, altered sensorium) 3.Patients with oesophageal or stomach pathology like achalasia cardia, hiatus hernia, CA oesophagus, CA stomach.
4.Patients who have undergone gastrectomy, gastric bypass surgery.
5.Patients who are unable to turn or lie down in lateral position.
6.Patients on drugs such as prokinetics which alter gastric motility or gastric emptying times.

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
1. To preoperatively examine the gastric contents and volume in fasting patients prior to elective surgery by determining the cross sectional area(CSA) of antrum by using bedside ultrasound.	2 Years
2. To determine the correlation between hours of preoperative fasting and gastric contents and volume.	2 Years

Secondary Outcome Measures

Name	Time	Method
Not Applicable	Not Applicable

Trial Locations

Locations (1): Lokmanya Tilak Municipal Medical College and General Hospital
🇮🇳
Mumbai, MAHARASHTRA, India
Lokmanya Tilak Municipal Medical College and General Hospital
🇮🇳Mumbai, MAHARASHTRA, India
Dr Sunil Bodamwad
Principal investigator
9999938164
drsunil33@gmail.com