Effect Of Gastric Ultrasonography In Assessing Gastric Emptying Of Women Undergoing Emergency Cesarean Section

Objective:Through the qualitative and quantitative ultrasound assessment of the gastric antrum in emergency cesarean section,it is studied whether the standard of preoperative satiety clinical judgment in adult adults is consistent with the judgment of gastric ultrasound in the emergency maternal population,and whether maternal ultrasound assessment of the gastric antrum can provide individualized information for preoperative anesthesia decision.Methods:143 pregnant patients who underwent emergency cesarean section from July 2017 to May 2018 were selected,with gestational age?36 weeks,age?18 years,ASA ? or ?and BMI<35kg/m2.Women were examined after entering the operating room.A standardized ultrasound examination of the gastric antrum was performed including the qualitative assessment of the gastric antrum and the quantitative assessment of the antral cross-sectional area(CSA)with 45° supine position and 45° right lateral position.Women were classified using a grading system(grade 0,no fluid;grade 1,fluid seen in right lateral decubitus position only;grade 2,fluid seen in both supine and right lateral decubitus positions;and grade 3,solid seen in one of the two positions).Parturient who met the gastric antrum score of grade 0 and grade 1 was defined as empty stomach,while who met the gastric antrum score of 2 or more was defined as full stomach.Then the gastric emptying of the parturient was clinically assessed by another anesthesiologist according to the practice guidelines for obstetric anesthesia(the beverage was banned 2 hours before surgery;starch solid food,milk and formula were banned 6 hours before surgery;fried,fat and meat foods were banned 8 hours before surgery).Parturient who met the standard of fasting by eating time and type was considered to have an empty stomach,or was considered to have a full stomach.Results:2 of the patients exhibited an empty stomach by both two methods(1.4%);105 of them exhibited an empty stomach by ultrasound but an full stomach by clinical judgment(73.4%);5 of them exhibited an full stomach by ultrasound but an empty stomach clinically(3.5%);and 31 of them exhibited an full stomach by both two methods(21.7%).The results of the two methods of judging gastric emptying was statistically significant,Kappa-0.063(P=0.004).The results of maternal gastric emptying was closely related to the type of last meal eaten,the amount of food eaten and the time interval from feeding to ultrasound examination.Every additional hour of eating to the ultrasound examination interval reduced the risk of ultrasonic judgment of full stomach by 0.37 times(OR=0.37;95%CI 0.20-0.67;P<0.001).Eating fat and meat foods increased the risk of ultrasonic judgment of full stomach by 372.73 times than eating starchy solid foods(OR=372.73;95%CI 18.70-7430.92;P<0.001).Each additional 100g food intaked increased the risk of full stomach by 5.70times(OR=5.70;95%CI 2.27-14.33;P<0.001).Conclusion:Bedside gastric ultrasound can reliably assess gastric emptying through the assessment of the gastric antrum in the perioperative period for women undergoing emergency cesarean section and provide objective guidance for clinical decision making.