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Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit

BACKGROUND AND AIMS: An audit was conducted between July 2017 and November 2017 to assess the adequacy of American Society of Anesthesiologists (ASA) fasting guidelines on 246 patients by means of gastric ultrasonography (USG). The relevance of this audit is that many of our patients have one or mor...

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Autores principales: Sharma, Sadhvi, Deo, Alka Sachin, Raman, Padmalatha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190433/
https://www.ncbi.nlm.nih.gov/pubmed/30443056
http://dx.doi.org/10.4103/ija.IJA_54_18
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author Sharma, Sadhvi
Deo, Alka Sachin
Raman, Padmalatha
author_facet Sharma, Sadhvi
Deo, Alka Sachin
Raman, Padmalatha
author_sort Sharma, Sadhvi
collection PubMed
description BACKGROUND AND AIMS: An audit was conducted between July 2017 and November 2017 to assess the adequacy of American Society of Anesthesiologists (ASA) fasting guidelines on 246 patients by means of gastric ultrasonography (USG). The relevance of this audit is that many of our patients have one or more risk factors for aspiration such as diabetes mellitus, chronic kidney disease (CKD), gastro-oesophageal reflux disease (GERD), and obesity. METHODS: This audit was a prospective observational study which included all patients posted for surgery within the audit period. Patients were fasted according to ASA fasting guidelines. Their gastric content was assessed preoperatively using USG. The residual gastric volume was calculated using a validated formula. Statistical correlation between gastric volumes and the risk factors were analysed. RESULTS: Of 246 patients, 69 (28.04%) had high residual gastric volume. We found no correlation between hours of fasting and residual gastric volume (P = 0.47). We found a linear correlation between rising body mass index and residual gastric volume (P < 0.0001). Patients with GERD had 2.3 times higher risk. The CKD patient subgroup had 24 patients (30%) with high residual gastric volume. No incidents of aspiration were noted. CONCLUSION: In our audit, we found that risk factor association has a greater effect on residual gastric volume than hours of fasting. While the current fasting guidelines are adequate for healthy individuals, they are not conclusive in patients with risk factors. Ultrasound assessment of preoperative gastric volume is an effective screening tool in patients with risk factors.
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spelling pubmed-61904332018-11-15 Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit Sharma, Sadhvi Deo, Alka Sachin Raman, Padmalatha Indian J Anaesth Original Article BACKGROUND AND AIMS: An audit was conducted between July 2017 and November 2017 to assess the adequacy of American Society of Anesthesiologists (ASA) fasting guidelines on 246 patients by means of gastric ultrasonography (USG). The relevance of this audit is that many of our patients have one or more risk factors for aspiration such as diabetes mellitus, chronic kidney disease (CKD), gastro-oesophageal reflux disease (GERD), and obesity. METHODS: This audit was a prospective observational study which included all patients posted for surgery within the audit period. Patients were fasted according to ASA fasting guidelines. Their gastric content was assessed preoperatively using USG. The residual gastric volume was calculated using a validated formula. Statistical correlation between gastric volumes and the risk factors were analysed. RESULTS: Of 246 patients, 69 (28.04%) had high residual gastric volume. We found no correlation between hours of fasting and residual gastric volume (P = 0.47). We found a linear correlation between rising body mass index and residual gastric volume (P < 0.0001). Patients with GERD had 2.3 times higher risk. The CKD patient subgroup had 24 patients (30%) with high residual gastric volume. No incidents of aspiration were noted. CONCLUSION: In our audit, we found that risk factor association has a greater effect on residual gastric volume than hours of fasting. While the current fasting guidelines are adequate for healthy individuals, they are not conclusive in patients with risk factors. Ultrasound assessment of preoperative gastric volume is an effective screening tool in patients with risk factors. Medknow Publications & Media Pvt Ltd 2018-10 /pmc/articles/PMC6190433/ /pubmed/30443056 http://dx.doi.org/10.4103/ija.IJA_54_18 Text en Copyright: © 2018 Indian Journal of Anaesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Sharma, Sadhvi
Deo, Alka Sachin
Raman, Padmalatha
Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit
title Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit
title_full Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit
title_fullStr Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit
title_full_unstemmed Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit
title_short Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit
title_sort effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: a clinical audit
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190433/
https://www.ncbi.nlm.nih.gov/pubmed/30443056
http://dx.doi.org/10.4103/ija.IJA_54_18
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