Prediction of gastric fluid volume by ultrasonography in infants undergoing general anaesthesia. (August 2021)

• Record Type: Journal Article
• Authors: Kim, Eun-Hee; Yoon, Hee-Chul; Lee, Ji-Hyun; Kim, Hee-Soo; Jang, Young-Eun; Ji, Sang-Hwan; Cho, Sung-Ae; Kim, Jin-Tae
• Is Part Of: British journal of anaesthesia. Volume 127:Number 2(2021)
• Page Start: 275
• Page End: 280
• Publication Date: 2021-08
• Subjects: aspiration -- gastric volume -- infants -- paediatric anaesthesia -- ultrasonography; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2021.03.039
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: Point-of-care ultrasonography can estimate gastric contents and volume to assess the risk of pulmonary aspiration; however, its use in infants has not been well validated. We aimed to develop a predictive model for estimating gastric fluid volume using ultrasonography in infants. Methods: This prospective observational study enrolled 200 infants (≤12 months) undergoing general anaesthesia. After anaesthetic induction, while preserving spontaneous respiration, we measured gastric antral cross-sectional area using ultrasonography in both the supine and right lateral decubitus positions. We then suctioned the gastric content and measured its volume. The primary outcome was development of a gastric fluid volume prediction model with multiple regression analysis. Agreement between the predicted volume and the suctioned volume was evaluated using a Bland–Altman plot. Results: Overall, 192 infants were included in the final analysis. Pearson correlation analysis showed that the gastric antral cross-sectional area in the supine ( P <0.001; correlation coefficient: 0.667) and right lateral decubitus ( P <0.001; correlation coefficient: 0.845) positions and qualitative antral grade ( P <0.001; correlation coefficient: 0.581) correlated with suctioned volume. We developed a predictive model: predicted volume (ml)=–3.7+6.5 × (right lateral decubitus cross-sectional area [cm 2 ])–3.9 (supine cross-sectional area [cm 2 ])+1.7 × grade ( P <0.01). When comparing the predicted volume and suctioned volume, the mean bias was 0.01 ml kg −1 and the limit of agreement was –0.58 to 0.62 ml kg −1 . Conclusions: Gastric fluid volume can be estimated using a predictive model based on ultrasonography data in infants. Clinical trial registration: NCT03155776.