When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients

• Published in: British journal of anaesthesia : BJA Vol. 118; no. 3; pp. 363 - 371
• Main Authors: Van de Putte, P., Vernieuwe, L., Jerjir, A., Verschueren, L., Tacken, M., Perlas, A.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-03-2017
• Subjects: fasted; gastric contents; gastric ultrasound
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aew435

Abstract
Background. Perioperative aspiration leads to significant morbidity and mortality. Point-of-care gastric ultrasound is an emerging tool to assess gastric content at the bedside.
Methods. We performed a retrospective cohort study of baseline gastric content on fasted elective surgical patients. The primary outcome was the incidence of full stomach (solid content or >1.5 ml kg−1 of clear fluid). Secondary outcomes included: gastric volume distribution (entire cohort, each antral grade); the association between gastric fullness, fasting intervals, and co-morbidities; anaesthetic management changes and incidence of aspiration.
Results. We identified 538 patients. Thirty-two patients (6.2%) presented with a full stomach. Nine of these (1.7%) had solid content and 23 (4.5%) had clear fluid >1.5 ml kg−1. An empty stomach was documented in 480 (89.8%) patients. The examination was inconclusive in the remaining 20 patients (5.0%). As expected, increasing antral grade was correlated with larger antral cross-sectional area and higher gastric volume (P<0.001). Of the 32 patients with a full stomach, only six had a documented risk factor for prolonged gastric emptying. The anaesthetic management was changed in all nine patients with solid content. No aspiration was reported.
Conclusions. This retrospective cohort study suggests that a small proportion of elective surgical patients may present with a full stomach despite the recommended duration of fasting. Further research is needed to establish the clinical implications of these findings in the elective setting. At present, the clinical role of gastric ultrasound continues to be for the evaluation of gastric contents to guide management when the risk of aspiration is uncertain or unknown.