Ultrasound assessment of the gastric contents for the guidance of the anaesthetic strategy in infants with hypertrophic pyloric stenosis: a prospective cohort study.
BACKGROUND
Evacuation of gastric content through a nasogastric tube, followed by rapid sequence induction, is usually recommended in infants undergoing pyloromyotomy. However, rapid sequence induction may be challenging, and is therefore controversial. Some anaesthetists regularly perform classical non-rapid induction technique, after blind aspiration of the gastric contents, although this aspiration may have been incomplete. This prospective observational study aimed to assess whether the ultrasound monitoring of the aspiration of the stomach contents, may be useful to appropriately guide the choice of the anaesthetic induction technique, in infants undergoing pyloromyotomy.


METHODS
Infants undergoing pyloromyotomy were consecutively included. Ultrasound assessment of the antrum was performed before and after the aspiration of the gastric contents through a 10 French gastric tube. The stomach was defined as empty when no content was seen in both supine and right lateral positions. The correlation between antral area and the aspirated gastric volume was also tested.


RESULTS
We analysed 34 infants. Ultrasound examination of the antrum failed in three infants. The stomach was empty in 30/34 infants (nine before aspiration, 21 after aspiration), allowing to perform a non-rapid induction technique in 88.2% of the infants. There was a significant correlation between antral area measured in right lateral decubitus and the aspirated gastric volume.


CONCLUSIONS
Our results suggest that the qualitative ultrasound assessment of the antral content may be a simple and useful point-of-care tool, for the choice of the most appropriate anaesthetic technique for pyloromyotomy according to the estimated risk of pulmonary aspiration of gastric contents.
Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France.
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Gagey
Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France.
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de Queiroz Siqueira
Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France.
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Desgranges
Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France.
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Combet
Department of Anaesthesia and Intensive Care, Centre Hospitalier de Villefranche-sur-Saône, Plateau d'Ouilly Gleizé, 69655 Villefranche-sur-Saône, France.
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Naulin
Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France University of Lyon, Claude Bernard Lyon 1 University, 43 boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.
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Chassard
Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500 Bron, France Inserm, U1032, LabTau, 151, cours Albert Thomas, 69003 Lyon, France lionel.bouvet@chu-lyon.fr.
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Bouvet
D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D005766:Gastrointestinal Contents / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000517:prevention & control; D007441:Intubation, Gastrointestinal; D000074433:Myotomy; D019095:Point-of-Care Systems; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D046248:Pyloric Stenosis, Hypertrophic / Q000000981:diagnostic imaging / Q000601:surgery*; D063466:Respiratory Aspiration of Gastric Contents / Q000209:etiology / Q000517:prevention & control; D014463:Ultrasonography / Q000379:methods
anesthesia, general; infant; pyloric antrum; stomach; ultrasound