Skip to main content

Pre-induction Ultrasonographic Evaluation of Gastric Residual Volume in Elective Gastrointestinal Cancer Surgeries

Indian Journal of Surgical Oncology volume 12, pages 841–846 (2021)Cite this article

Abstract

Pulmonary aspiration of gastric contents during elective surgery remains a major cause of airway-related mortality and morbidity. The preoperative fasting times for solids and liquids have been standardized across various anesthesia society guidelines. Enhanced Recovery After Surgery (ERAS) guidelines now advocate liberal clear fluid intake with carbohydrate loading up to 2 h preoperatively. The aim of the study was to assess whether practicing both ASA fasting guidelines and ERAS protocol makes the patients prone to a full stomach. The supine position standard curvilinear ultrasound probe (2–5 MHz) with Sonosite M-Turbo ©system was used to obtain the images. Gastric residual volume (GRV) was derived from the cross-sectional area (CSA) using the Perlas and colleagues model. A total of 102 patients were recruited and analyzed. The mean age and BMI were 50.65 years ± 13.35 years and 22.23 kg/m2 ± 3.7 kg/m2, respectively. A total of four patients (3.92%) had gastric volume > 1.5 ml/kg; out of these four patients, three were female and one was male. We did not observe any case of pulmonary aspiration in any of our patients. In conclusion, even though for elective surgeries, the current fasting guidelines are adequate, these findings cannot be extrapolated to patients with risk factors for high gastric residual volume where further studies need to be performed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Cook TM, Woodall N, Frerk C, Fourth National Audit Project (2011) Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society Part 1: anaesthesia. Br J Anaesth 106(5):617–31. https://doi.org/10.1093/bja/aer058

    Article  CAS  PubMed  Google Scholar 

  2. El-Boghdadly K, Wojcikiewicz T, Perlas A (2019) Perioperative point-of-care gastric ultrasound. BJA Educ 19(7):219–226. https://doi.org/10.1016/j.bjae.2019.03.003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Melnyk M, Casey RG, Black P, Koupparis AJ (2011) Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can UrolAssoc J 5:342–348. https://doi.org/10.5489/cuaj.11002

    Article  Google Scholar 

  4. Van de Putte P, Vernieuwe L, Jerjir A, Verschueren L, Tacken M, Perlas A (2017) When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients. Br J Anaesth 118(3):363–371. https://doi.org/10.1093/bja/aew435

    Article  PubMed  Google Scholar 

  5. Doctor JR, Chandan P, Shetty N, Gala K, Ranganathan P (2021) Ultrasound-guided assessment of gastric residual volume in patients receiving three types of clear fluids: a randomised blinded study. Indian J Anaesth 65:289–294. https://doi.org/10.4103/ija.IJA_1291_20

    Article  PubMed  PubMed Central  Google Scholar 

  6. Krishnan B, Babu S, Walker J, Walker AB, Pappachan JM (2013) Gastrointestinal complications of diabetes mellitus. World J Diabetes 4(3):51–63. https://doi.org/10.4239/wjd.v4.i3.51

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kerrigan DD, Read NW, Houghton LA, Taylor ME, Johnson AG (1991) Disturbed gastroduodenal motility in patients with active and healed duodenal ulceration. Gastroenterology 100(4):892–900. https://doi.org/10.1016/0016-5085(91)90261-i

    Article  CAS  PubMed  Google Scholar 

  8. Tanaka M (2005) Gastroparesis after a pylorus-preserving pancreatoduodenectomy. Surg Today 35(5):345–350. https://doi.org/10.1007/s00595-004-2961-8

    Article  PubMed  Google Scholar 

  9. Yaylali O, Kirac S, Yilmaz M, Akin F, Yuksel D, Demirkan N, Akdag B (2009) Does hypothyroidism affect gastrointestinal motility? Gastroenterol Res Pract 2009:529802. https://doi.org/10.1155/2009/529802

    Article  PubMed  Google Scholar 

  10. Goetze O, Wieczorek J, Mueller T, Przuntek H, Schmidt WE, Woitalla D (2005) Impaired gastric emptying of a solid test meal in patients with Parkinson’s disease using 13C-sodium octanoate breath test. Neurosci Lett 375(3):170–173. https://doi.org/10.1016/j.neulet.2004.11.007

    Article  CAS  PubMed  Google Scholar 

  11. Jeong ID, Camilleri M, Shin A, Iturrino J, Boldingh A, Busciglio I, Burton D, Ryks M, Rhoten D, Zinsmeister AR (2012) A randomised, placebo-controlled trial comparing the effects of tapentadol and oxycodone on gastrointestinal and colonic transit in healthy humans. Aliment Pharmacol Ther 35(9):1088–1096. https://doi.org/10.1111/j.1365-2036.2012.05040.x

    Article  CAS  PubMed  Google Scholar 

  12. Kaufman PN, Krevsky B, Malmud LS, Maurer AH, Somers MB, Siegel JA, Fisher RS (1998) Role of opiate receptors in the regulation of colonic transit. Gastroenterology 94(6):1351–1356. https://doi.org/10.1016/0016-5085(88)90673-7

    Article  Google Scholar 

  13. Bouras EP, Talley NJ, Camilleri M, Burton DD, Heckman MG, Crook JE, Richelson E (2008) Effects of amitriptyline on gastric sensorimotor function and postprandial symptoms in healthy individuals: a randomized, double-blind, placebo-controlled trial. Am J Gastroenterol 103(8):2043–2050. https://doi.org/10.1111/j.1572-0241.2008.02021.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sakai T, Planinsic RM, Quinlan JJ, Handley LJ, Kim TY, Hilmi IA (2006) The incidence and outcome of perioperative pulmonary aspiration in a university hospital: a 4-year retrospective analysis. Anesth Analg 103(4):941–947. https://doi.org/10.1213/01.ane.0000237296.57941.e7

    Article  PubMed  Google Scholar 

  15. Warner MA, Warner ME, Weber JG (1993) Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 78(1):56–62. https://doi.org/10.1097/00000542-199301000-00010

    Article  CAS  PubMed  Google Scholar 

  16. Benhamou D (2015) Ultrasound assessment of gastric contents in the perioperative period: why is this not part of our daily practice? Br J Anaesth 114(4):545–548. https://doi.org/10.1093/bja/aeu369

    Article  CAS  PubMed  Google Scholar 

  17. Meineri M, Bryson GL, Arellano R, Skubas N (2018) Core point-of-care ultrasound curriculum: what does every anesthesiologist need to know? Can J Anaesth 65(4):417–426. https://doi.org/10.1007/s12630-018-1063-9 (English)

    Article  PubMed  Google Scholar 

  18. Lucas DN, Elton CD (2016) Through a glass darkly – ultrasound imaging in obstetric anaesthesia. Anaesthesia 71(6):617–622. https://doi.org/10.1111/anae.13466

    Article  CAS  PubMed  Google Scholar 

  19. Manchikanti L, Colliver JA, Marrero TC, Roush JR (1985) Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients. Anesth Analg 64(1):11–17

    Article  CAS  Google Scholar 

  20. Kaydu A, Gokcek E (2018) Preoperative assessment of ultrasonographic measurement of antral area for gastric content. Med SciMonit 24:5542–5548. https://doi.org/10.12659/MSM.908520

    Article  Google Scholar 

  21. Harter RL, Kelly WB, Kramer MG, Perez CE, Dzwonczyk RR (1998) A comparison of the volume and pH of gastric contents of obese and lean surgical patients. Anesth Analg 86(1):147–152. https://doi.org/10.1097/00000539-199801000-00030

    Article  CAS  PubMed  Google Scholar 

  22. Sharma S, Deo AS, Raman P (2018) Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: a clinical audit. Indian J Anaesth 62(10):747–752. https://doi.org/10.4103/ija.IJA_54_18

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dupont G, Gavory J, Lambert P, Tsekouras N, Barbe N, Presles E, Bouvet L, Molliex S (2017) Ultrasonographic gastric volume before unplanned surgery. Anaesthesia 72(9):1112–1116. https://doi.org/10.1111/anae.13963

    Article  CAS  PubMed  Google Scholar 

  24. Sabry R, Hasanin A, Refaat S, Abdel Raouf S, Abdallah AS, Helmy N (2019) Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound. Acta Anaesthesiol Scand 63(5):615–619. https://doi.org/10.1111/aas.13315

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, 2nd Floor Main Building, Dr E Borges Marg, Parel, Mumbai, India

    Reshma Ambulkar, Unnathi Manampadi, Shilpushp Bhosale, Vandana Agarwal & Sohan Lal Solanki

  2. Department of Anesthesiology & Critical Care, Glenfield Hospital, Leicester, UK

    Meenal Rana

Authors
  1. Reshma Ambulkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Unnathi Manampadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shilpushp Bhosale
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meenal Rana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vandana Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sohan Lal Solanki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reshma Ambulkar.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ambulkar, R., Manampadi, U., Bhosale, S. et al. Pre-induction Ultrasonographic Evaluation of Gastric Residual Volume in Elective Gastrointestinal Cancer Surgeries. Indian J Surg Oncol 12, 841–846 (2021). https://doi.org/10.1007/s13193-021-01456-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-021-01456-9

Keywords

  • Aspiration
  • ERAS
  • Fasting
  • Gastric volume
  • Ultrasonography