The Outcome of Pre-operative Gastric Ultrasound Examination on the Choice of General Anaesthetic Induction Technique in Paediatric Patients Posted for Surgery - An Observational Study

Abstract

BACKGROUND & AIM: Ultrasonographic assessment of the gastric antrum, is a non-invasive reliable tool for gastric content estimation in both adults and children. This study aimed to determine the most appropriate induction technique and assessment of gastric content by aspiration of nasogastric tube. METHODOLOGY: 80, ASA I and II paediatric patients aged 6 months to 16 years were considered. Ultrasound was performed preoperatively in semi-recumbent and right lateral decubitus position to assess the gastric content. Perlas grading 0-2 was used to determine the gastric volume. A final induction plan (Routine or Rapid Sequence Induction-RSI) was made based on this assessment. Immediately after tracheal intubation, gastric contents were suctioned through a nasogastric tube; these were defined as above risk threshold for regurgitation and aspiration if there was clear fluid > 0.8 ml/kg, and/or the presence of thick fluid and/or solid particles. RESULTS: Out of 80 patients examined, RSI was performed in 23 after assessing by ultrasonography. p value was highly significant (<0.0001) for appropriate technique of induction based on Perlas grade. Confirmation of gastric volume by nasogastric tube aspiration was also highly significant (p<0.0001). CONCLUSION: Ultrasonography is a useful guide to assess the gastric volume to aid for the choice of general anaesthetic technique that can reduce risk of pulmonary aspiration.