ULTRASOUND – FASTING FOR SURGERY

We’ve held on to our strict fasting regimes for decades. Gastric ultrasound is here to help us individualise our fasting rules a bit more. Gastric ultrasound has lots of uses, and lately it’s become fashionable to use it for evaluating surgical patients immediately pre-op to see if they’re fasted.

Screenshot 2016-04-20 20.19.23

Changing anaesthetic practice?
Ultrasound use has exploded. Both in doctors using it as well as what it is used for. Some years ago, most docs would find lung ultrasound ludicrus, now it’s taking over as standard of care in many settings. Another field recently gaining traction is gastric ultrasound for pre-operative fasting.

Studies suggest that even anaesthetists can be fairly competent at gastric ultrasound for fasting after 30 or so examinations. Maybe should ultrasound be a part of our daily routine – especially in emergency settings and fasting ‘grey areas’.

25B1

It could be used for emergency patients you know are not fasting to better evaluate the potential damage regurgitation could cause. Is the stomach of your ileus patient filled with liters of food and fluids, or does it look rather empty? And also for those we know have a potential for delayed gastric emptying – is that diabetes or pregnant patient really fasted after 6 hours? This would have the potential to make our anaesthetic induction safer.

The other side is to make it more effective, but this might take you into unchartered territory. It could have the potential to evaluate patients for earlier surgery, if their stomachs are empty on ultrasound before the 6 hour fasting period, and do away with unnecessary fasting in small kids and others where this needs to be weighted against aspiration risk.

Gastricultrasound.org
As most radiologist ultrasonographers don’t know that much about it, a dedicated website with how-to, reference images and links to evidence for its use is a great resource to get you started!

This is one of few – and free – resources out there that’s well designed and looks good – and packs all the info you need:

http://gastricultrasound.org

Ultrasound assessment of gastric contents in the perioperative period: why is this not part of our daily practice?, editorial, BJA, 2015.

Ultrasound assessment of gastric content and volume, review, BJA, 2014.

Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study, Can J Anaesth, 2013.

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