Assessment of gastric content by using gastric ultrasound (pocgus) prior to transesophageal echocardiogram: advantages and recommendations.
DOI:
https://doi.org/10.37615/retic.v8n3a3Keywords:
aspiration, point-of- care gastric ultrasound, transesophageal echocardiographyAbstract
Risk of gastric aspiration (inhalation of oral, pharyngeal or gastric contents into the lower airways) during an anesthetic procedure or in the perioperative period is directly associated with an increase in morbidity and mortality or permanent injuries. Transesophageal Echocardiography (TEE) could be considered similar to an upper endoscopy or gastroscopy with abolition of gastrointestinal tract reflexes during sedation and the consequent risk of pulmonary aspiration especially if they experience risk factors. In the setting prior to performing TEE in the adult patient, gastric ultrasound performed by the same echocardiographer and without changing the transducer or configuration or preset can confirm or rule out a full stomach and risk of aspiration, so this article is a proposal for an approach to reduce aspiration during the procedure and its respective complications.
Downloads
Metrics
References
Warner, Mark A., Mary Ellen Warner, and Joseph G. Weber. "Clinical significance of pulmonary aspiration during the perioperative period." Anesthesiology 78.1 (1993): 56-62. https://doi.org/10.1097/00000542-199301000-00010 DOI: https://doi.org/10.1097/00000542-199301000-00010
Lienhart, André, et al. "Preliminary results from the SFAR-iNSERM inquiry on anaesthesia-related deaths in France: mortality rates have fallen ten-fold over the past two decades." Bulletin de L'academie Nationale de Medecine 188.8 (2004): 1429-37. https://doi.org/10.1016/s0001-4079(19)33666-0 DOI: https://doi.org/10.1016/S0001-4079(19)33666-0
MENDELSON, CURTIS L. "The aspiration of stomach contents into the lungs during obstetric anesthesia." Survey of Anesthesiology 38.03 (1994): 185. https://doi.org/10.1097/00132586-199406000-00059 DOI: https://doi.org/10.1097/00132586-199406000-00059
Lienhart, Andre, et al. "Survey of anesthesia-related mortality in France." The Journal of the American Society of Anesthesiologists 105.6 (2006): 1087-1097. https://doi.org/10.1097/00000542-200612000-00008 DOI: https://doi.org/10.1097/00000542-200612000-00008
- Hahn, Rebecca T., et al. "Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists." Journal of the American Society of Echocardiography 26.9 (2013): 921-964. https://doi.org/10.1016/j.echo.2013.07.009 DOI: https://doi.org/10.1016/j.echo.2013.07.009
-Cook, Tim, Jane Harper, and Nick Woodall. "Report of the NAP4 airway project." Journal of the Intensive Care Society 12.2 (2011): 107-111. https://doi.org/10.1177/175114371101200206 DOI: https://doi.org/10.1177/175114371101200206
- Warner, Mark A., et al. "Pulmonary aspiration of gastric contents: a closed claims analysis." Anesthesiology 135.2 (2021): 284-291.
https://doi.org/10.1097/aln.0000000000003831 DOI: https://doi.org/10.1097/ALN.0000000000003831
- Sakai, Tetsuro, et al. "The incidence and outcome of perioperative pulmonary aspiration in a university hospital: a 4-year retrospective analysis." Anesthesia & Analgesia 103.4 (2006): 941-947. https://doi.org/10.1213/01.ane.0000237296.57941.e7 DOI: https://doi.org/10.1213/01.ane.0000237296.57941.e7
- Berkmen, Yahya M. "Aspiration and inhalation pneumonias." Seminars in roentgenology. Vol. 15. No. 1. WB Saunders, 1980.
https://doi.org/10.1016/0037-198x(80)90040-1 DOI: https://doi.org/10.1016/0037-198X(80)90040-1
- Raidoo, D. M., et al. "Critical volume for pulmonary acid aspiration: reappraisal in a primate model." BJA: British Journal of Anaesthesia 65.2 (1990): 248-250. https://doi.org/10.1093/bja/65.2.248 DOI: https://doi.org/10.1093/bja/65.2.248
- Van de Putte, Peter, et al. "When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients." BJA: British Journal of Anaesthesia 118.3 (2017): 363-371. https://doi.org/10.1093/bja/aew435 DOI: https://doi.org/10.1093/bja/aew435
- Hakak, S., C. L. McCaul, and L. Crowley. "Ultrasonographic evaluation of gastric contents in term pregnant women fasted for six hours." International Journal of Obstetric Anesthesia 34 (2018): 15-20. https://doi.org/10.1016/j.ijoa.2018.01.004 DOI: https://doi.org/10.1016/j.ijoa.2018.01.004
- Kluger, M. T., and T. G. Short. "Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS)." Anaesthesia 54.1 (1999): 19-26. https://doi.org/10.1046/j.1365-2044.1999.00642.x DOI: https://doi.org/10.1046/j.1365-2044.1999.00642.x
- Green, S. M., K. P. Mason, and B. S. Krauss. "Pulmonary aspiration during procedural sedation: a comprehensive systematic review." BJA: British Journal of Anaesthesia 118.3 (2017): 344-354. https://doi.org/10.1093/bja/aex004 DOI: https://doi.org/10.1093/bja/aex004
- Wang, Jing, et al. "Ultrasonic assessment of gastric solid contents in patients undergoing upper endoscope with sedation." BMC anesthesiology 24.1 (2024): 317. https://doi.org/10.1186/s12871-024-02688-2 DOI: https://doi.org/10.1186/s12871-024-02688-2
- Kallmeyer, Ian J., et al. "The safety of intraoperative transesophageal echocardiography: a case series of 7200 cardiac surgical patients." Anesthesia & Analgesia 92.5 (2001): 1126-1130. https://doi.org/10.1097/00000539-200105000-00009 DOI: https://doi.org/10.1097/00000539-200105000-00009
- Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. The Journal of the American Society of Anesthesiologists 96(4):p 1004-1017, April 1, 2002. https://doi.org/10.1097/00000542-200204000-00031 DOI: https://doi.org/10.1097/00000542-200204000-00031
- Force, ASA Task. "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologists Task Force on Preoperative Fasting." Anesthesiology 90 (1999): 896-905. https://doi.org/10.1097/00000542-199903000-00034 DOI: https://doi.org/10.1097/00000542-199903000-00034
- Tm, Cook. "Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia." Br J Anaesth 106 (2011): 617-631. https://doi.org/10.1093/bja/aer058 DOI: https://doi.org/10.1093/bja/aer058
- Joshi, Girish P., et al. "2023 American society of anesthesiologists practice guidelines for preoperative fasting: carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration—a modular update of the 2017 American society of anesthesiologists practice guidelines for preoperative fasting." Anesthesiology 138.2 (2023): 132-151.
https://doi.org/10.1097/aln.0000000000004381 DOI: https://doi.org/10.1097/ALN.0000000000004381
-Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. An Updated Report by the American Society of Anesthesiologists Task Force on Preopera- tive Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376–93.
https://doi.org/10.1097/aln.0000000000001452 DOI: https://doi.org/10.1097/ALN.0000000000001452
- American Society of Anesthesiologists Committee. "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters." Anesthesiology 114.3 (2011): 495-511. https://doi.org/10.1097/aln.0b013e3181fcbfd9 DOI: https://doi.org/10.1097/ALN.0b013e3181fcbfd9
- van Zuylen, Mark L., et al. "Perioperative management of long-acting glucagon-like peptide-1 (GLP-1) receptor agonists: concerns for delayed gastric emptying and pulmonary aspiration." British Journal of Anaesthesia 132.4 (2024): 644-648.
https://doi.org/10.1016/j.bja.2024.01.001 DOI: https://doi.org/10.1016/j.bja.2024.01.001
- Jalleh, Ryan J., et al. "Gastrointestinal effects of GLP-1 receptor agonists: mechanisms, management, and future directions." The Lancet Gastroenterology & Hepatology 9.10 (2024): 957-964. https://doi.org/10.1016/s2468-1253(24)00188-2 DOI: https://doi.org/10.1016/S2468-1253(24)00188-2
- Sen, Sudipta, et al. "Glucagon-like peptide-1 receptor agonist use and residual gastric content before anesthesia." JAMA surgery 159.6 (2024): 660-667. https://doi.org/10.1001/jamasurg.2024.0111 DOI: https://doi.org/10.1001/jamasurg.2024.0111
- McIsaac, Daniel I., and Gregory L. Bryson. "Glucagon-like peptide-1 receptor agonists and aspiration risk." bmj 387 (2024).
https://doi.org/10.1136/bmj.q1986 DOI: https://doi.org/10.1136/bmj.q1986
- Marroquin‐Harris, M., and B. Olesnicky. "Aspiration risk with glucagon‐like peptide 1 (GLP‐1) agonists." Anaesthesia 78.12 (2023): 1524-1524. https://doi.org/10.1111/anae.16099 DOI: https://doi.org/10.1111/anae.16099
- Gulak, Michael A., and Patricia Murphy. "Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 70.8 (2023): 1397-1400.
https://doi.org/10.1007/s12630-023-02521-3 DOI: https://doi.org/10.1007/s12630-023-02521-3
- Fujino, Erina, et al. "Anesthesia considerations for a patient on semaglutide and delayed gastric emptying." Cureus 15.7 (2023).
https://doi.org/10.7759/cureus.42153 DOI: https://doi.org/10.7759/cureus.42153
- Sherwin, Marc, et al. "Influence of semaglutide use on the presence of residual gastric solids on gastric ultrasound: a prospective observational study in volunteers without obesity recently started on semaglutide." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 70.8 (2023): 1300-1306. https://doi.org/10.1007/s12630-023-02549-5 DOI: https://doi.org/10.1007/s12630-023-02549-5
- Yeo, Yee Hui, et al. "Increased risk of aspiration pneumonia associated with endoscopic procedures among patients with glucagon-like peptide 1 receptor agonist use." Gastroenterology 167.2 (2024): 402-404. https://doi.org/10.1053/j.gastro.2024.03.015 DOI: https://doi.org/10.1053/j.gastro.2024.03.015
- Dixit, Anjali A., et al. "Preoperative GLP-1 receptor agonist use and risk of postoperative respiratory complications." Jama 331.19 (2024): 1672-1673. https://doi.org/10.1001/jama.2024.5003 DOI: https://doi.org/10.1001/jama.2024.5003
- Wu, Fei, et al. "Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 71.7 (2024): 958-966. https://doi.org/10.1007/s12630-024-02719-z DOI: https://doi.org/10.1007/s12630-024-02781-7
- Camilleri, Michael. "Definite benefits of GLP-1 receptor agonists: what is the risk of gastroparesis and lung aspiration?." Gut 74.3 (2025): 342-345. https://doi.org/10.1136/gutjnl-2024-333036 DOI: https://doi.org/10.1136/gutjnl-2024-333036
- Amini, Ruaa Al Sakka, et al. "Risk of Aspiration Pneumonitis After Elective Esophagogastroduodenoscopy in Patients on Glucagon-Like Peptide-1 Receptor Agonists." Cureus 16.8 (2024). https://doi.org/10.7759/cureus.66311 DOI: https://doi.org/10.7759/cureus.66311
- Alkabbani, Wajd, et al. "Glucagon-like peptide-1 receptor agonists before upper gastrointestinal endoscopy and risk of pulmonary aspiration or discontinuation of procedure: cohort study." bmj 387 (2024). https://doi.org/10.1136/bmj-2024-080340 DOI: https://doi.org/10.1136/bmj-2024-080340
- Ushakumari, Deepu S., and Robert N. Sladen. "ASA consensus-based guidance on preoperative management of patients on glucagon-like peptide-1 receptor agonists." Anesthesiology (2023). https://doi.org/10.1097/aln.0000000000004776 DOI: https://doi.org/10.1097/ALN.0000000000004776
- Marino, E. C., et al. "Rastreio e controle da hiperglicemia no perioperatório." Diretriz Oficial da Sociedade Brasileira de Diabetes [Internet] (2023): 5238993-2023. https://doi.org/10.29327/5238993.2023-7 DOI: https://doi.org/10.29327/5238993.2023-7
- Wang, Jing, et al. "Ultrasound assessment of gastric residual volume in patients over 60 years of age undergoing gastroscopy under sedation: a prospective cohort study." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 70.8 (2023): 1315-1322. https://doi.org/10.1007/s12630-023-02523-1 DOI: https://doi.org/10.1007/s12630-023-02523-1
- Arzola, Christian, et al. "Bedside Gastric Ultrasonography in Term Pregnant Women Before Elective Cesarean Delivery: A Prospective Cohort Study." Obstetric Anesthesia Digest 36.3 (2016): 146-147. https://doi.org/10.1097/01.aoa.0000489470.14780.bd
- Sabry, Rabab, et al. "Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound." Acta Anaesthesiologica Scandinavica 63.5 (2019): 615-619. https://doi.org/10.1111/aas.13315
- Kruisselbrink, R., et al. "Ultrasound assessment of gastric volume in severely obese individuals: a validation study." BJA: British Journal of Anaesthesia 118.1 (2017): 77-82. https://doi.org/10.1093/bja/aew400
-Ohashi Y, Walker JC, Zhang F, et al. Preoperative gastric residual volumes in fasted patients measured by bedside ultrasound: a
prospective observational study. Anaesth Intensive Care 2018; 46: 608-13. https://doi.org/10.1177/0310057x1804600612 DOI: https://doi.org/10.1177/0310057X1804600612
-Bouvet L, Desgranges FP, Aubergy C, Boselli E, Dupont G, Allaouchiche B, et al. Prevalence and factors predictive of full stomach in elective and emergency surgical patients: a prospective cohort study. BJA Br J Anaesth. 2017;118(3):372–9. https://doi.org/10.1093/bja/aew462 DOI: https://doi.org/10.1093/bja/aew462
-Nimmo WS, Wilson J, Prescott LF. Narcotic analgesics and delayed gastric emptying during labour. Lancet (London, England). 1975;1(7912):890–3. https://doi.org/10.1016/s0140-6736(75)91687-6 DOI: https://doi.org/10.1016/S0140-6736(75)91687-6
-Billeaud C, Guillet J, Sandler B. Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk. Eur J Clin Nutr. 1990;44(8):577–83. https://doi.org/10.1136/gut.47.5.661 DOI: https://doi.org/10.1136/gut.47.5.661
- Splinter, W. M., and J. D. Schaefer. "Ingestion of clear fluids is safe for adolescents up to 3 h before anaesthesia." British Journal of Anaesthesia 66.1 (1991): 48-52. https://doi.org/10.1093/bja/66.1.48 DOI: https://doi.org/10.1093/bja/66.1.48
- Maughan, R. J., and J. B. Leiper. "Methods for the assessment of gastric emptying in humans: an overview." Diabetic Medicine: a Journal of the British Diabetic Association 13.9 Suppl 5 (1996): S6-10.
- Kline, J., et al. "Accuracy in evaluating gastric ultrasound images before and after brief training." Anaesthesiology Ready to submit your research (2017).
- Ramsingh, Davinder, John Christian Fox, and William C. Wilson. "Perioperative point-of-care ultrasonography: an emerging technology to be embraced by anesthesiologists." Anesthesia & Analgesia 120.5 (2015): 990-992. https://doi.org/10.1213/ane.0000000000000702 DOI: https://doi.org/10.1213/ANE.0000000000000702
- Kendall, John L., Stephen R. Hoffenberg, and R. Stephen Smith. "History of emergency and critical care ultrasound: the evolution of a new imaging paradigm." Critical care medicine 35.5 (2007): S126-S130. https://doi.org/10.1097/01.ccm.0000260623.38982.83 DOI: https://doi.org/10.1097/01.CCM.0000260623.38982.83
- Perlas, Anahi, Cristian Arzola, and Peter Van de Putte. "Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review." Canadian Journal of Anesthesia 65.4 (2018): 437-448. https://doi.org/10.1007/s12630-017-1031-9 DOI: https://doi.org/10.1007/s12630-017-1031-9
- Haskins, S. C., et al. "Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist." Obstetric Anesthesia Digest 39.3 (2019): 139-140. https://doi.org/10.1097/01.aoa.0000575168.45176.55 DOI: https://doi.org/10.1097/01.aoa.0000575168.45176.55
- Perlas, Anahi, et al. "Ultrasound assessment of gastric content and volume." The Journal of the American Society of Anesthesiologists 111.1 (2009): 82-89. https://doi.org/10.1097/aln.0b013e3181a97250 DOI: https://doi.org/10.1097/ALN.0b013e3181a97250
- Bouvet, Lionel, et al. "Could a single standardized ultrasonographic measurement of antral area be of interest for assessing gastric contents? A preliminary report." European Journal of Anaesthesiology| EJA 26.12 (2009): 1015-1019. https://doi.org/10.1097/eja.0b013e32833161fd DOI: https://doi.org/10.1097/EJA.0b013e32833161fd
- Segura-Grau, Elena, et al. "Reinforcing the valuable role of gastric ultrasound for volume and content assessment: an observational study." Brazilian Journal of Anesthesiology 72.06 (2022): 749-756. https://doi.org/10.1016/j.bjane.2021.07.008 DOI: https://doi.org/10.1016/j.bjane.2021.07.008
- Van de Putte, Peter, and Anahí Perlas. "Ultrasound assessment of gastric content and volume." British journal of anaesthesia 113.1 (2014): 12-22. https://doi.org/10.1093/bja/aeu151 DOI: https://doi.org/10.1093/bja/aeu151
- Arzola, Christian, et al. "Bedside Gastric Ultrasonography in Term Pregnant Women Before Elective Cesarean Delivery: A Prospective Cohort Study." Obstetric Anesthesia Digest 36.3 (2016): 146-147. https://doi.org/10.1097/01.aoa.0000489470.14780.bd
- Sabry, Rabab, et al. "Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound." Acta Anaesthesiologica Scandinavica 63.5 (2019): 615-619. https://doi.org/10.1111/aas.13315 DOI: https://doi.org/10.1111/aas.13315
- Kruisselbrink, R., et al. "Ultrasound assessment of gastric volume in severely obese individuals: a validation study." BJA: British Journal of Anaesthesia 118.1 (2017): 77-82. https://doi.org/10.1093/bja/aew400 DOI: https://doi.org/10.1093/bja/aew400
- Bolondi, L. "Correlation between scintigraphic and ultrasonographic assessement of gastric emptying." Gastroenterology 90 (1986): 1349. https://doi.org/10.1016/0016-5085(95)26789-1 DOI: https://doi.org/10.1016/0016-5085(95)26789-1
- Giron Arango, Laura, and Anahi Perlas. "Gastric point-of-care ultrasound: a diagnostic tool that is coming of age?." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 70.8 (2023): 1291-1294. https://doi.org/10.1007/s12630-023-02524-0 DOI: https://doi.org/10.1007/s12630-023-02524-0
- READ, MS, and RS VAUGHAN. "Allowing Pre-Operative Patients to Drink: Effects on Patient's Safety and Comfort of Unlimited Oral Water Until 2 Hours Before Anesthesia." Survey of Anesthesiology 36.3 (1992): 150. https://doi.org/10.1097/00132586-199206000-00023 DOI: https://doi.org/10.1097/00132586-199236030-00023
- Agarwal, A., P. Chari, and H. Singh. "Fluid deprivation before operation: the effect of a small drink." Anaesthesia 44.8 (1989): 632-634. https://doi.org/10.1111/j.1365-2044.1989.tb13581.x DOI: https://doi.org/10.1111/j.1365-2044.1989.tb13581.x
- Perlas, Anahi, et al. "Gastric sonography in the fasted surgical patient: a prospective descriptive study." Anesthesia & Analgesia 113.1 (2011): 93-97. https://doi.org/10.1213/ane.0b013e31821b98c0 DOI: https://doi.org/10.1213/ANE.0b013e31821b98c0
- Arzola, Christian, et al. "Bedside Gastric Ultrasonography in Term Pregnant Women Before Elective Cesarean Delivery: A Prospective Cohort Study." Obstetric Anesthesia Digest 36.3 (2016): 146-147. https://doi.org/10.1097/01.aoa.0000489470.14780.bd DOI: https://doi.org/10.1097/01.aoa.0000489470.14780.bd
- Perlas, Anahi, et al. "Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination." Anesthesia & Analgesia 116.2 (2013): 357-363. https://doi.org/10.1213/ane.0b013e318274fc19
- Bouvet, Lionel, et al. "Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume." The Journal of the American Society of Anesthesiologists 114.5 (2011): 1086-1092. https://doi.org/10.1097/aln.0b013e31820dee48 DOI: https://doi.org/10.1097/ALN.0b013e31820dee48
- Sharma S, Deo AS, Raman P. Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit. Indian J Anaesth. 2018;62(10):747-752. https://doi.org/10.4103/ija.ija_54_18 DOI: https://doi.org/10.4103/ija.IJA_54_18
- Patil, Manjunath C., Pavan V. Dhulkhed, and B. Prajwal. "Ultrasonographic estimation of gastric volume in patients after overnight fasting and after ingestion of clear fluids two hours before surgery." Anaesthesia, Pain & Intensive Care 24.3 (2020):308-313.
https://doi.org/10.35975/apic.v24i3.1283 DOI: https://doi.org/10.35975/apic.v24i3.1283
-Srinivasareddy, Shubha. "Gastric Ultrasound for Gastric Content Evaluation." Turkish Journal of Anaesthesiology and Reanimation 51.6 (2023): 465. https://doi.org/10.4274/tjar.2023.231479 DOI: https://doi.org/10.4274/TJAR.2023.231479
- Perlas, Anahi, et al. "Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination." Anesthesia & Analgesia 116.2 (2013): 357-363. https://doi.org/10.1213/ane.0b013e318274fc19 DOI: https://doi.org/10.1213/ANE.0b013e318274fc19
- Brady, Marian C., et al. "Preoperative fasting for adults to prevent perioperative complications." Cochrane database of systematic reviews 2010.5 (1996). https://doi.org/10.1002/14651858.cd004423 DOI: https://doi.org/10.1002/14651858.CD004423
- Ajuzieogu, O. V., et al. "Effect of routine preoperative fasting on residual gastric volume and acid in patients undergoing myomectomy." Nigerian journal of clinical practice 19.6 (2016): 816-820. https://doi.org/10.4103/1119-3077.180049 DOI: https://doi.org/10.4103/1119-3077.180049
- Scarr, M., et al. "Volume and acidity of residual gastric fluid after oral fluid ingestion before elective ambulatory surgery." CMAJ: Canadian Medical Association Journal 141.11 (1989): 1151.
- Borland, Lawrence M., et al. "Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome." Journal of Clinical Anesthesia 10.2 (1998): 95-102. https://doi.org/10.1016/s0952-8180(97)00250-x DOI: https://doi.org/10.1016/S0952-8180(97)00250-X
- Gola, Wojciech, Michał Domagała, and Adam Cugowski. "Ultrasound assessment of gastric emptying and the risk of aspiration of gastric contents in the perioperative period." Anaesthesiology intensive therapy 50.4 (2018). https://doi.org/10.5603/ait.a2018.0029 DOI: https://doi.org/10.5603/AIT.a2018.0029
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Juan Antonio Calderón González, José María Hernández Hernández
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
RETIC is distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license https://creativecommons.org/licenses/by-nc-nd/4.0 which allows sharing, copying and redistribution of the material in any medium or format, under the following terms:
- Attribution: you must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests that the licensor endorses you or your use.
- Non-commercial: you may not use the material for commercial purposes.
- No Derivatives: if you remix, transform or build upon the material, you may not distribute the modified material.
- No Additional Restrictions: you may not apply legal terms or technological measures that legally restrict others from doing anything permitted by the license.
