Reinforcing the valuable role of gastric ultrasound for volume and content assessment: an observational study

Abstract Background Pulmonary aspiration is one of the most important complications in anesthesiology. Assessment of gastric content by ultrasound is a good method to quantify gastric volume and to determine the risk of intraoperative pulmonary aspiration. The aim of this study is to determine the accuracy of the gastric ultrasonography in the qualitative analysis of gastric content, mainly in the analysis of small amounts of liquid content. Methods Gastric ultrasound was performed to 36 patients before upper gastrointestinal endoscopy (UGI), making two longitudinal scans at the epigastric level, one in supine position and the other in right lateral decubitus position, measuring two diameters and the area of the gastric antrum and assessing the content characteristics determining whether it was an empty stomach or contained fluid or solid content. Subsequently, the ultrasound findings were compared with UGI findings. Results Gastric areas were analyzed by the trace and the lengths of the craniocaudal and anteroposterior axes concluding that there are no significant differences between the two methods. No statistically significant difference was found between UGI and US assessment technics. No statistically significant difference was found between the estimated volume by UGI and US. Conclusions Though our study has some limitations, qualitative analysis of gastric content using ultrasound followed by endoscopy enabled the conclusion that there are no differences in the qualitative assessment regarding these two techniques, supporting the important role of point-of-care gastric ultrasound (POCGUS) in the assessment of pulmonary aspiration risk by the anesthesiologist in the perioperative period.

Reinforcing the valuable role of gastric ultrasound for volume and content assessment: an observational study.

BACKGROUND: Pulmonary aspiration is one of the most important complications in anesthesiology. Assessment of gastric content by ultrasound is a good method to quantify gastric volume and to determine the risk of intraoperative pulmonary aspiration. The aim of this study is to determine the accuracy of the gastric ultrasonography in the qualitative analysis of gastric content, mainly in the analysis of small amounts of liquid content. METHODS: Gastric ultrasound was performed to 36 patients before upper gastrointestinal endoscopy (UGI), making two longitudinal scans at the epigastric level, one in supine position and the other in right lateral decubitus position, measuring two diameters and the area of the gastric antrum and assessing the content characteristics determining whether it was an empty stomach or contained fluid or solid content. Subsequently, the ultrasound findings were compared with UGI findings. RESULTS: Gastric areas were analyzed by the trace and the lengths of the craniocaudal and anteroposterior axes concluding that there are no significant differences between the two methods. No statistically significant difference was found between UGI and US assessment technics. No statistically significant difference was found between the estimated volume by UGI and US. CONCLUSIONS: Though our study has some limitations, qualitative analysis of gastric content using ultrasound followed by endoscopy enabled the conclusion that there are no differences in the qualitative assessment regarding these two techniques, supporting the important role of point-of-care gastric ultrasound (POCGUS) in the assessment of pulmonary aspiration risk by the anesthesiologist in the perioperative period.

Ultrasonographic evaluation of gastric content and volume: a systematic review.

OBJECTIVE: Bronchoaspiration of gastric content is associated with high morbidity and mortality, but evaluating this complication is a difficult task. However, gastric ultrasonography can safely assess gastric content and prevent bronchoaspiration. Therefore, a systematic review was performed in order to verify the efficacy of ultrasonography in the qualitative and quantitative analyses of gastric content. METHODS: A literature review of articles published between 2009 and 2019 in the PubMed and LILACS databases was conducted using combinations of the keywords "gastric ultrasound," "gastric emptying," and "gastric content." RESULTS: Of the 20 articles found, 19 chose the antral region as the best site for qualitative analysis of the gastric content. Regarding quantitative measurement, the most commonly used method to calculate the gastric volume in eight articles was the formula "Gastric Volume = 27 + (14.6 × ATAG) - (1.28 × Age)," in which the area of the transverse section of the gastric antrum (ATAG) could also be calculated by the largest antral diameters or by free tracing. CONCLUSION: An efficient evaluation of the gastric content can be performed by ultrasonography of the antral region, contributing to greater safety in the clinical management of patients with increased risk for bronchoaspiration during airway management.

Ultrasonographic evaluation of gastric content and volume: a systematic review

SUMMARY OBJECTIVE: Bronchoaspiration of gastric content is associated with high morbidity and mortality, but evaluating this complication is a difficult task. However, gastric ultrasonography can safely assess gastric content and prevent bronchoaspiration. Therefore, a systematic review was performed in order to verify the efficacy of ultrasonography in the qualitative and quantitative analyses of gastric content. METHODS: A literature review of articles published between 2009 and 2019 in the PubMed and LILACS databases was conducted using combinations of the keywords "gastric ultrasound," "gastric emptying," and "gastric content." RESULTS: Of the 20 articles found, 19 chose the antral region as the best site for qualitative analysis of the gastric content. Regarding quantitative measurement, the most commonly used method to calculate the gastric volume in eight articles was the formula "Gastric Volume = 27 + (14.6 × ATAG) − (1.28 × Age)," in which the area of the transverse section of the gastric antrum (ATAG) could also be calculated by the largest antral diameters or by free tracing. CONCLUSION: An efficient evaluation of the gastric content can be performed by ultrasonography of the antral region, contributing to greater safety in the clinical management of patients with increased risk for bronchoaspiration during airway management.

RESUMO OBJETIVO: A broncoaspiração do conteúdo gástrico associa-se à alta morbimortalidade, porem a avaliação desta complicação é tarefa dificil. Por outro lado, a ultrassonografia gástrica avalia o conteúdo gástrico com segurança, podendo evitar a broncoaspiração. Portanto, foi realizada revisão sistemática com objetivo de verificar a aplicabilidade da ultrassonografia na análise qualitativa e quantitativa do conteúdo gástrico. MÉTODOS: Revisão de literatura de artigos publicados entre 2009 e 2019 nas bases de dados PubMed e LILACS usando combinações das palavras chave: "Gastric ultrasound", "gastric emptying" e "gastric content". RESULTADOS: Foram encontrados 20 artigos. A região antral foi escolhida em 19 artigos como melhor local do ponto de vista qualitativo para analisar o conteúdo gástrico. A respeito da mensuração quantitativa, o método mais utilizado para cálculo do volume gástrico, escolhido em 8 artigos, foi através da fórmula Volume gástrico = 27 + (14,6 x ATAG) - (1,28 x Idade), em que a Área da Secção Transversa do Antro Gástrico (ATAG) pode ser igualmente calculada pelos maiores diâmetros antrais ou pelo seu traçado livre. CONCLUSÃO: A ultrassonografia da região antral permite boa avaliação do conteúdo gástrico, trazendo maior segurança ao manejo clínico de pacientess com risco aumentado para broncoaspiração no manejo da via aerea.

Carboxymethylcellulose and psyllium effects in sand output of horses with asymptomatic sand accumulation / [Efeitos da carboximetilcelulose e do psyllium sobre a eliminação de areia de cavalos com sablose assintomática]

The aim of this study was to evaluate the effects of Psyllium (PSY) and Carboxymethylcellulose (CMC) administration on fecal elimination of sand in horses with asymptomatic sand accumulations. Eight horses were selected from sandy areas and randomly divided into 2 groups of four animals. The subjects were treated either with CMC or PSY. The presence of intestinal sand was confirmed through radiography and glove sedimentation test. The study was performed in two phases, with a 7-day interval. In phase I, all the animals received 8 liters of warm water; in phase II, the CMC group received 8 liters of water + 1g/kg of CMC, whereas the PSY group received 8 liters of water + 1g/kg of PSY. All administrations were performed through nasogastric intubation and fractionated in 2 equal volume administrations with an interval of two hours. General and specific physical examination of the digestive system were performed in conjunction with abdominal ultrasonography before the administrations and after 6, 12, 24, 36 and 48 hours, aiming to evaluate intestinal motility and presence of sand. All the feces eliminated by the animals within the 72 hours following the administrations were quantified, diluted and sedimented in order to calculate the sand output (g/kg of feces). All the animals were also subjected to radiographic examination to quantify sand accumulation prior to phase I and after 72 hours of phases I and II. No adverse effects were observed after the treatments. It was possible to notice higher sand elimination in both groups during the phase I, whereas no difference was observed in sand elimination rates between the groups in phase II. The radiographic scores presented differences between the initial timepoint and 72h in phases I and II for both groups. Based on the sand elimination rates and radiographic score, this study demonstrated that sand output was greater after administration of water alone, compared to CMC and Psyllium, leading to the inference that removal of the sandy environment and prevention of sand re-ingestion are effective measures for the elimination of sand from the colon of horses with asymptomatic sand accumulations.(AU)

O objetivo deste estudo foi avaliar os efeitos da administração do psyllium (PSY) e da carboximetilcelulose (CMC) sobre a eliminação fecal de areia em equinos com sablose assintomática. Oito equinos com confirmação radiográfica de sablose assintomática foram divididos em dois grupos (grupo CMC e grupo PSY). O estudo foi realizado em duas fases, com intervalo de sete dias. Na fase 1, todos os animais receberam 8L de água; na fase 2, o grupo CMC recebeu 8L de água + 1g/kg de CMC e o grupo PSY recebeu 8L de água + 1g/kg de PSY. Antes da administração de cada solução e após seis, 12, 24, 36 e 48 horas, foram realizados exame físico e ultrassonografia abdominal. Todas as fezes eliminadas em 72 horas foram avaliadas para quantificar a eliminação de areia (g/kg de fezes). Antes da fase 1 e após 72 horas das fases 1 e 2, o exame radiográfico foi realizado para quantificar o escore de acúmulo de areia. Houve maior eliminação de areia após a administração de água em comparação com a administração de CMC, e não se observou diferença entre a CMC e o PSY. Uma redução significativa nos escores radiográficos de acúmulo de areia foi observada após a administração de água, bem como a manutenção dos escores após a administração da CMC e do PSY. Com base na produção de areia e no escore radiográfico, este estudo sugere que a remoção do ambiente arenoso, impedindo a reingestão de areia, é uma medida eficaz para a eliminação da areia do cólon de cavalos com acúmulos de areia assintomáticos.(AU)

Ultrasonido para la valoración del contenido gástrico: revisión sistemática de la literatura / Ultrasound for the assessment of gastric content: a systematic review

INTRODUCTION: Pneumonic aspiration of gastric contents is an important complication of anesthetic practice. : OBJECTIVE: To determine the applicability of ultrasound for the assessment of the qualitative and quantitative characteristics of gastric contents. MATERIAL AND METHODS: A systematic review was carried out, based on a structured search of the literature published in the databases: Pubmed, EMBASE, SciELO, Cochrane Library, OVID and Google Scholar, from the foundation of these until December 2018 Boolean connectors were used to locate information from the terms: anesthesiology, ultrasonography, gastrointestinal Contents. The quality of the information was assessed using different tools according to each type of study. RESULTS: We found 23 relevant studies for inclusion in the systematic review. The overall risk of bias was low. CONCLUSIONS: Gastric ultrasound seems to correspond to a tool that is easy to perform at the patient's bedside, but there is uncertainty about its applicability in uncontrolled settings, different from those applied in the studies described in this review. More research is needed with different populations and scenarios, in favor of establishing the behavior in these, of the variables that can be determined by ultrasound. The implications for clinical practice and long-term outcomes may have the measurements achieved by ultrasound are still uncertain.

INTRODUCCIÓN: La aspiración neumónica del contenido gástrico es una complicación importante de la práctica anestésica. OBJETIVO: Determinar la aplicabilidad del ultrasonido para la valoración de las características cualitativas y cuantitativas del contenido gástrico. MATERIALES Y MÉTODOS: Se realizó una revisión sistemática, a partir de una búsqueda estructurada de la literatura publicada en las bases de datos: Pubmed, EMBASE, SciELO, Cochrane Library, OVID y Google Scholar, desde la fundación de las mismas hasta diciembre de 2018. Se utilizaron conectores booleanos para localizar información a partir de los términos: anesthesiology, ultrasonography, gastrointestinal Contents. La calidad de la información fue valorada mediante diferentes herramientas de acuerdo a cada tipo de estudio. RESULTADOS: Se encontraron 23 estudios pertinentes para su inclusión en la revisión sistemática. El riesgo global de sesgo fue bajo. CONCLUSIONES: El ultrasonido gástrico parece corresponder a una herramienta de fácil realización a la cabecera del paciente, pero existe incertidumbre sobre su aplicabilidad en contextos no controlados, diferentes a los aplicados en los estudios descritos en la presente revisión. Se necesita más investigación con distintas poblaciones y escenarios, en favor de establecer el comportamiento en estos, de las variables que pueden determinarse por ultrasonido. Las implicaciones que para la práctica clínica y desenlaces a largo plazo puedan tener las mediciones logradas mediante ecografía son aún inciertas.

Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section / Ultrassom de antro gástrico em gestantes a termo antes de cesariana eletiva

Abstract Background and objectives: Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. Method: In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. Results: The median (IIQ) for gastric antral cross-sectional area was 4 cm2 (2.8-6.3), for the estimated gastric volume it was 49.8 mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62 mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3 cm2 (95% CI: 7.6-15.6) and 1.42 mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p < 0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p < 0.01 and p < 0.02. Conclusion: Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.

Resumo Justificativa e objetivos: As gestantes são consideradas pacientes de risco para aspiração pulmonar do conteúdo gástrico. O objetivo foi avaliar a área transversal do antro gástrico por meio de ultrassonografia. Método: Neste estudo prospectivo, 85 gestantes a termo agendadas foram submetidas à ultrassonografia do antro gástrico. Os desfechos foram a mensuração da área transversal do antro gástrico (desfecho principal), a estimativa do volume gástrico, a incidência de gestantes sob risco de aspiração pulmonar, a associação entre a área transversal do antro gástrico e características clínico-demográficas. A área transversal do antro gástrico e do volume gástrico foi comparada de acordo com o índice de massa corporal < 30 ou ≥ 30. Resultados: A mediana (IIQ) da área transversal do antro gástrico foi 4 cm2 (2,8-6,3), do volume gástrico estimado 49,8 mL (33,7-87,2) e do volume gástrico estimado em mL.kg-1 de 0,62 mL.kg-1 (0,39-0,95). O percentil 95 [intervalo de confiança (IC) 95%] da área transversal do antro gástrico e do volume gástrico estimado foi ≤ 10,3 cm2 (IC 95%: 7,6-15,6) e 1,42 mL.kg-1 (IC 95%: 1,20-2,64), respectivamente. A incidência de gestantes sob risco de aspiração pulmonar foi de 3,5% (IC: 3,5 (1,2-9,8). Houve correlação positiva entre a área transversal do antro gástrico e peso, p < 0,001 e índice de massa corporal p < 0,001. As pacientes com índice de massa corporal ≥ 30 apresentaram maior área transversal do antro gástrico, e do volume gástrico estimado, do que as com índice de massa corporal < 30, respectivamente p < 0,01 e p < 0,02. Conclusão: A mensuração da área transversal do antro gástrico de gestantes é factível e fácil. A área transversal do antro gástrico correlacionou-se positivamente com peso e índice de massa corporal. A estimativa do volume gástrico através da mensuração da área transversal do antro gástrico pode identificar pacientes sob risco de aspiração pulmonar. As pacientes obesas apresentaram área transversal do antro gástrico e volume gástrico estimado maior do que as não obesas.

Ultrasound examination of coelomic viscera through the plastron in stranded green sea turtles (Chelonia mydas).

Many projects have been developed in the last years for the conservation of sea turtles. Young green turtles (Chelonia mydas) often nest on the Brazilian coast. Because they nest in beaches along the coastline and islands, green turtles are susceptible to fishing and accidental ingestion of anthropogenic debris. Early detection of ingested debris is crucial for the survival of rescued sea animals. Ultrasound (US) has emerged as a viable imaging technique for visceral examination in veterinary medicine. Previous studies have suggested the left and right cervicobrachial, axillary, pre- and post-femoral areas as the only viable approaches for US examination, but the acoustic windows available for imaging of coelomic structures are limited. It is important to notice that a detailed evaluation of all gastrointestinal tracts, especially the duodenum, is crucial for detecting foreign bodies and intestinal obstructive processes, as well as obtaining essential information such as intestinal motility and heart frequency. Intestinal motility and heartbeats are not detected through radiographic examination or through the acoustic windows available so far. This study aimed to establish the viability of US examination of coelomic viscera through the plastron in stranded green turtles. Eleven young green turtles rescued by the GREMAR Institute were examined. Turtles were placed in the dorsal decubitus position during US examination, which did not require anesthesia. Even though the plastron is constituted of bones and cartilage, the present research has proven the viability of obtaining US images through it, making it possible to visualize structures undetectable through the acoustic windows previously suggested. The following organs were evaluated through the plastron: heart, stomach, duodenum, jejunum, colon, liver, gallbladder, kidneys, bladder, and spleen (in case of splenomegaly). US imaging through the plastron is a viable approach for detecting ingested artificial debris, which represents one of the leading causes of death among sea turtles.

[Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section]. / Ultrassom de antro gástrico em gestantes a termo antes de cesariana eletiva.

BACKGROUND AND OBJECTIVES: Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. METHOD: In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥ 30. RESULTS: The median (IIQ) for gastric antral cross-sectional area was 4cm2 (2.8-6.3), for the estimated gastric volume it was 49.8mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤ 10.3cm2 (95% CI: 7.6-15.6) and 1.42mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8). There was a positive correlation between gastric antral cross-sectional area and weight, p <0.001 and body mass index <0.001. Patients with a body mass index ≥ 30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p <0.01 and p <0.02. CONCLUSION: Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.

Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers / Dinâmica ultrassonográfica dos volumes do conteúdo gástrico após a ingestão de água de coco ou sanduíche de carne. Um estudo cruzado controlado e randômico com voluntários saudáveis

Abstract Background: Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. Methods: We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10 h and was subjected to a baseline gastric ultrasound, intake of 400 mL of coconut water or a 145 g, 355 kcal meat sandwich, and sonographic gastric evaluations after 10 min and every hour until the stomach was completely empty. Results: At baseline, all subjects had an empty stomach. At 10 min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2 mL for liquid and solid foods, respectively (p > 0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9 h for liquid and solid foods, respectively (p < 0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. Conclusions: Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.

Resumo Justificativa: O jejum pré-operatório adequado é fundamental para prevenir a aspiração pulmonar do conteúdo gástrico. Nossa proposta foi avaliar a dinâmica ultrassonográfica do conteúdo gástrico após a ingestão de alimentos líquidos ou sólidos em voluntários sadios e confrontá-la com as diretrizes atuais para os períodos de jejum no pré-operatório. Métodos: Um estudo prospectivo, cruzado e avaliador-cego foi feito com 17 voluntários saudáveis de ambos os sexos. Cada participante jejuou por 10 horas e foi submetido a uma ultrassonografia gástrica na fase basal, ingestão de 400 mL de água de coco ou 355 g de sanduíche de carne e avaliações gástricas ultrassonográficas foram feitas após 10 minutos e a cada hora até o estômago estar completamente vazio. Resultados: Na fase basal, todos os participantes estavam com o estômago vazio. Aos 10 minutos, o conteúdo gástrico [média + desvio-padrão (DP)] foi de 240,4 + 69,3 e 248,2 + 119,2 mL para alimentos líquidos e sólidos, respectivamente (p > 0,05). Os tempos médios de esvaziamento gástrico + DP foram de 2,5 + 0,7 e 4,5 + 0,9 horas para alimentos líquidos e sólidos, respectivamente (p < 0,001). Para a bebida, o estômago ficou completamente vazio em 59% e 100% dos sujeitos após duas e quatro horas; para o sanduíche, o estômago ficou completamente vazio em 65% e 100% dos sujeitos após quatro e sete horas, respectivamente. Conclusões: A dinâmica ultrassonográfica do volume gástrico para água de coco e sanduíche de carne resultou em tempos totais de esvaziamento gástrico maiores e menores, respectivamente, do que os sugeridos pelas diretrizes atuais para o jejum pré-operatório.

[Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers]. / Dinâmica ultrassonográfica dos volumes do conteúdo gástrico após a ingestão de água de coco ou sanduíche de carne. Um estudo cruzado controlado e randômico com voluntários saudáveis.

BACKGROUND: Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. METHODS: We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10h and was subjected to a baseline gastric ultrasound, intake of 400mL of coconut water or a 145g, 355kcal meat sandwich, and sonographic gastric evaluations after 10min and every hour until the stomach was completely empty. RESULTS: At baseline, all subjects had an empty stomach. At 10min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2mL for liquid and solid foods, respectively (p>0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9h for liquid and solid foods, respectively (p<0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. CONCLUSIONS: Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.

Gavage Feed Volume Determines the Gastric Emptying Rate in Preterm Infants.

OBJECTIVE: Feeding intolerance, manifesting as increased gastric residual, is a common finding in preterm neonates. Little is known about the regulation of gastric emptying early in life and the extent to which this plays a role in the preterm infants' feeding tolerance. The goal of this study was to evaluate clinically stable 28- to 32-week gestation neonates during the first 4 weeks of life and noninvasively determine their gastric emptying rate. STUDY DESIGN: Ultrasound measurements of gastric milk content volume were obtained from 25 neonates immediately after, 30 and/or 60 minutes following routine gavage feeds. The content emptying rate was calculated from the gastric volume data. RESULTS: Gastric emptying rate was not postnatal age-dependent, was significantly higher at 30 minutes, whenever compared with 60-minute postfeed and directly proportional to the feed volume. At any postnatal age, the gastric emptying rate was at least 6-fold greater, when comparing the lowest and highest average stomach content volumes. CONCLUSIONS: The gastric emptying rate of preterm infants is content volume-dependent and unrelated to the postnatal age. Given the present findings, further investigation on the gastric residual of preterm infants receiving larger than currently administered feed volumes at the initiation of enteral nutrition, is warranted.

Qualitative and quantitative ultrasound assessment of gastric content.

OBJECTIVE:: Pulmonary aspiration of the gastric contents is one of the most feared complications in anesthesia. Its prevention depends on preoperative fasting as well as identification of risky patients. A reliable diagnostic tool to assess gastric volume is currently lacking. The aim of this study performed on volunteers was to evaluate the feasibility of ultrasonography to identify qualitative and quantitative gastric content. METHOD:: A standardized gastric scanning protocol was applied on 67 healthy volunteers to assess the gastric antrum in four different situations: fasting, after ingesting clear fluid, milk and a solid meal. A qualitative and quantitative assessment of the gastric content in the antrum was performed by a blinded sonographer. The antrum was considered either as empty, or containing clear or thick fluid, or solids. Total gastric volume was predicted based on a cross-sectional area of the antrum. A p-value less than 0.05 was considered statistically significant. RESULTS:: For each type of gastric content, the sonographic characteristics of the antrum and its content were described and illustrated. Sonographic qualitative assessment allowed to distinguish between an empty stomach and one with different kinds of meal. The predicted gastric volume was significantly larger after the consumption of any food source compared to fasting. CONCLUSION:: Bedside sonography can determine the nature of gastric content. It is also possible to estimate the difference between an empty gastric antrum and one that has some food in it. Such information may be useful to estimate the risk of aspiration, particularly in situations when prandial status is unknown or uncertain.

Qualitative and quantitative ultrasound assessment of gastric content / Avaliação qualitativa e quantitativa do conteúdo gástrico através da ultrassonografia

Summary Objective: Pulmonary aspiration of the gastric contents is one of the most feared complications in anesthesia. Its prevention depends on preoperative fasting as well as identification of risky patients. A reliable diagnostic tool to assess gastric volume is currently lacking. The aim of this study performed on volunteers was to evaluate the feasibility of ultrasonography to identify qualitative and quantitative gastric content. Method: A standardized gastric scanning protocol was applied on 67 healthy volunteers to assess the gastric antrum in four different situations: fasting, after ingesting clear fluid, milk and a solid meal. A qualitative and quantitative assessment of the gastric content in the antrum was performed by a blinded sonographer. The antrum was considered either as empty, or containing clear or thick fluid, or solids. Total gastric volume was predicted based on a cross-sectional area of the antrum. A p-value less than 0.05 was considered statistically significant. Results: For each type of gastric content, the sonographic characteristics of the antrum and its content were described and illustrated. Sonographic qualitative assessment allowed to distinguish between an empty stomach and one with different kinds of meal. The predicted gastric volume was significantly larger after the consumption of any food source compared to fasting. Conclusion: Bedside sonography can determine the nature of gastric content. It is also possible to estimate the difference between an empty gastric antrum and one that has some food in it. Such information may be useful to estimate the risk of aspiration, particularly in situations when prandial status is unknown or uncertain.

Resumo Objetivo: A aspiração pulmonar do conteúdo gástrico é uma das complicações mais temidas em anestesia. A sua prevenção depende do jejum pré-operatório e da identificação dos pacientes de risco. Não há um método diagnóstico que possa acessar o conteúdo gástrico a qualquer momento. O objetivo deste estudo realizado em voluntários foi fazer uma avaliação qualitativa e quantitativa do conteúdo gástrico utilizando a ultrassonografia. Método: O estudo foi realizado em 67 voluntários utilizando uma técnica já descrita de avaliação do antro gástrico, em quatro diferentes situações: jejum, após a ingestão de líquido claro, leite ou refeição sólida. Foi feita uma avaliação qualitativa e quantitativa do conteúdo gástrico por um radiologista que desconhecia o estado gástrico do voluntário. O antro foi considerado vazio, contendo líquido claro ou espesso, ou sólido. O volume total do estômago foi calculado com base na área seccional do antro. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados: Para cada tipo de conteúdo gástrico, as características ultrassonográficas do antro e de seu conteúdo foram descritas e ilustradas. A avaliação qualitativa pode distinguir um estômago vazio de outros com diferentes conteúdos. O volume gástrico calculado foi significativamente maior após a ingestão de qualquer alimento em comparação com o jejum. Conclusão: A ultrassonografia à beira do leito pode determinar a natureza do conteúdo gástrico. Também foi possível diferenciar um antro vazio daquele com algum volume. Essas informações podem ser úteis na determinação do risco de aspiração gástrica, principalmente se a condição gástrica é desconhecida ou incerta.

Presença de corpos estranhos no aparelho digestorio de jabutis piranga (Chelonoidis carbonaria): relato de caso / Presence of foreign bodies in the digestive system of the jabuti piranga (Chelonoidis carbonaria): a case report

A ingestão de corpos estranhos por répteis cativos está relacionada à manutenção destes animais em ambientes impróprios. O presente relato refere-se à descrição de casos de ingestão de corpos estranhos em três jabutis piranga (Chelonoidis carbonaria) oriundos de criações domiciliares do Estado de Sergipe, Brasil. Os animais foram encaminhados para atendimento médico com histórico de apatia, prostração, perda de apetite e constipação. Após anamnese e avaliação clínica os mesmos foram submetidos a radiografias ventrodorsal simples que confirmaram a presença de materiais radiopacos nas vias digestivas. As condutas terapêuticas foram diferenciadas e um dos animais veio a óbito devido à gravidade de seu estado clínico. A partir desse relato podemos concluir que a ocorrência de ingestão de corpos estranhos pode ocorrer quando o manejo é inadequado.

The ingestion of foreign bodies by captive reptiles is related to the maintenance of these animals in unsuitable places. This report refers to the description of ingestion cases of weird foreign bodies by three jabuti piranga (Chelonoidis carbonaria) from keepers in Sergipe, Brazil. The animals were sent for medical care with a history of apathy, prostration, loss of appetite and constipation. After anamnesis and clinical evaluation the specimens were submitted to simple ventrodorsal radiographs that confirmed the presence of radiopaque material in the digestive tract. Therapeutic procedures were different and one of the animals died due to the seriousness of his condition. From that report we concluded that the occurrence of ingestion of foreign bodies may occur when treatment is inadequate.

Assessment of the post-prandial distribution of intragastric contents using an automated technique.

The distribution of intragastric contents has been studied using operator-dependent methods. We devised an automated technique for determining post-prandial intragastric distribution of radiolabeled meals, based on the calculation of the 'center of activity' (CA) of the radioactivity contained in the stomach in any given scintigraphic image. Twelve healthy volunteers and eleven functional dyspepsia (FD) patients ingested a liquid meal (320 mL, 450 kcal) labeled with (99m)Technetium-phytate. Images of the stomach were acquired every 5-10 min for 2 h, and counted to determine the percentage of total activity retained in the upper half of the stomach, as visually delineated. Each image was then processed using an algorithm for calculating a CA value representing the average of image-forming points corrected by pixel number. The relative CA position along the main longitudinal axis of the stomach, as defined by a digital 'skeletonizing' process, was expressed in a '0 to 1' scale. In the FD patients, the average of all CA determinations was significantly higher than in the controls (0.56, 0.30-0.80 versus 0.48, 0.33-0.68, p < 0.05) and correlated significantly with proximal stomach retention values assessed by a visual method (R = -0.64, p < 0.001). Assessing post-prandial intragastric distribution by a novel automated method is feasible and yields reliable data, while being much less operator dependent.