What’s in that Belly??? - PowerPoint Presentation

Slide1

What’s in that Belly???

The Utility of Gastric Ultrasonography in the Preoperative Suite

Amy M. Reed, Ph.D., CRNA

Is this a problem?

Anesthesia Training

circa 2013-2014

~1 year

CRNA Practice

NAP

Faculty 2016

Is this a problem?

SUBJECTIVE

OBJECTIVE

VOLUME (ML) =27.0 + 14.6 X RIGHT-LAT CSA – 1.28 X AGE

Type II Diabetes Mellitus:

Relationships between Preoperative Physiologic Stress, Gastric Content Volume & Quality & the Risk for Pulmonary Aspiration

POSITIONING/TECHNIQUE

Abdominal settings

Transducer:

Large pediatric or adults: curved array low-frequency (2-5

mHz

)Small children: linear high-frequency

(5-12 mHz)Scan the epigastrium in a sagittal plane

Sweep the transducer from the left to the right subcostal marginsIdentify the gastric antrum –next slides!Patient position:

Start in the supine positionFollow with the right lateral decubitus (RLD). Never call an empty stomach based on the supine position alone

EMPTY

CLEARS

CLEARS w/ AIR BUBBLES

SOLIDS

www.gastricultrasound.org

REFERENCES

Abell, T. L., Camilleri, M., Donohoe, K., Hasler, W. L., Lin, H. C., Maurer, A. H., . . . Shreve, P. (2008). Consensus recommendations for gastric emptying scintigraphy: A joint report of the American

Neurogastroenterology

and Motility Society and the Society of Nuclear Medicine. 

American Journal of Gastroenterology

, 103, 753-763. doi:10.1111/j.1572-0241.2007.01636.xage. 2018. In Merriam-Webster.com. Retrieved March 5, 2017. From https://www.merriam-webster.com/dictionary/age Agostoni, M., Fanti, L., Gemma, M., Pasculli

, N., Beretta, L., & Testoni, P. (2011). Adverse events during monitored anesthesia care for GI endoscopy: and 8-year experience. Gastrointestinal Endoscopy, 74, 266-275. doi:10.1016/j.gie.2011.04.028Alakkad, H., Kruisselbrink

, R., Chin, K. J., Niazi, A. U., Abbas, S., Chan, V. W., & Perlas, A. (2015). Point-of-care ultrasound defines gastric content and changes the anesthetic management of elective surgical patients who have not followed fasting instructions: A prospective case series. Canadian Journal of Anesthesia/Journal Canadien

d'Anesthésie, 62, 1188-1195. doi:10.1007/s12630-015-0449-1American Academy of Family Physicians. (2013). Documenting diabetes mellitus under ICD-10. Retrieved from http://www.aafp.orgAmerican Association of Nurse Anesthetists. (2016). Informed consent in anesthesia. Retrieved from https://www.aana.com

American College of Surgeons. (2018). General surgery. Retrieved by https://www.facs.orgAmerican Diabetes Association. (2017). Statistics about diabetes. Retrieved from http://www.diabetes.orgAmerican Society of Anesthesiologists Committee. (2011). 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, 376-393. doi:10.1097/ALN.0000000000001452Arhakis, A., Karagiannis, V., & Kalfas, S. (2013). Salivary alpha-amylase activity and salivary flow rate in young adults

. Open Dentistry Journal, 7, 7–15. doi:10.2174/1874210601307010007Arzola, C., Carvalho, J. C., Cubillos, J., Xiang, Y. Y., & Perlas

, A. (2013). Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: A cohort study. Canadian Journal of Anesthesia/Journal Canadien d'Anesthésie, 60, 771-779. doi:10.1007/s12630-013-9974Asai, T. (2004). Editorial II: Who is at increased risk of pulmonary aspiration? British Journal of Anaesthesia, 93, 497-500. doi:10.1093/

bja/aeh234Bouvet, L., & Chassard, D. (2014a). Contribution of ultrasonography for the preoperative assessment of gastric contents. Annales Francaises d'Anesthesie

et de Reanimation, 33(4), 240-247. doi:10.1097/00006842-1996070000-00010Bouvet, L., & Chassard, D. (2014b). Ultrasound assessment of gastric content in the obese patient: One more step for patient safety. Anesthesia & Analgesia, 119, 1017-1018. doi:10.1213/ANE.0000000000000403

Bouvet, L., Miquel, A., Chassard, D., Boselli, E., Allaouchiche, B., & Benhamou, D. (2009). Could a single standardized ultrasonographic measurement of antral area be of interest for assessing gastric contents? A preliminary report. 

European Journal of Anaesthesiology, 26, 1015-1019. doi:10.1097/EJA.0b013e32833161fdBrady, M. C., Kinn, S., Stuart, P., & Ness, V. (2003). Preoperative fasting for adults to prevent perioperative complications. The Cochrane Database of Systematic Reviews, 4, doi:10.1002/14651858.CD004423

Canadian Society of Intestinal Research. (2018). Gastroparesis overview. Retrieved from https://www.badgut.orgCenters for Disease Control and Prevention. (2017). National diabetes statistics report. Retrieved from https://www.cdc.govChon, T., Ma, A., & Mun-Price, C. (2018). Perioperative fasting and the patient experience. Cureus

, 9, 1272-1279. doi:10.7759/cureus.1272Clement, S., Braithwaite, S. S., Magee, M. F., Ahmann, A., Smith, E. P., Schafer, R. G., & Hirsch, I. B. (2004). Management of diabetes and hyperglycemia in hospitals. Diabetes Care, 27, 553-591. doi:10.2337/diacare.27.553

Cohen, J. (1988). Statistical power analysis for the behavioral sciences

(2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.Cook, T. M., Woodall, N., & Frerk, C. O. (2011). 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

. 

British Journal of Anaesthesia, 

106, 617-631. doi:10.1093/bja/aer058Crenshaw, J. T., & Winslow, E. H. (2008). Preoperative fasting duration and medication instruction: Are we improving? Association of PeriOperative Registered Nurses

Journal, 88, 963-976. doi:10.1016/j.aorn.2008.07.017Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. London, UK: Sage.Cubillos, J.,

Tse, C., Chan, V. W., & Perlas, A. (2012). Bedside ultrasound assessment of gastric content: An observational study. Canadian Journal of Anesthesia/Journal Canadien d'Anesthésie

, 59, 416-423. doi:10.1007/s12630-011-9661-9Dagogo-Jack, S., & Alberti, K. G. M. (2002). Management of diabetes mellitus in surgical patients. Diabetes Spectrum, 

15, 44-48. doi:10.2337/diaspect.15.1.44Das, S., & Ghosh, S. (2015). Monitored anesthesia care: An overview. Journal of Anesthesiology Clinical Pharmacology, 31, 27-29. doi:10.4103/0970-9185.150525Diabetes.co.uk. (2018). Fasting blood sugar levels. AORN.

Retrieved from https://www.diabetes.co.uk/ diabetes care /fasting-blood-sugar-levels.html Donohue, C., Hobson, B., & Stephens, R. C. (2013). An introduction to anaesthesia. British Journal of Hospital Medicine, 74

, C71-C75. doi:10.12968/hmed.2013.74.SUP5.C71Durbin, J., & Watson, G. S. (1950). Testing for serial correlation in least squares regression. Biometrika, 37, 409-428. doi:10.2307/2332391 Faul, F., Erdfelder, E., Lang A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.

Behavioral Research Methods, 39, 175-191. doi:10.3758/BF03193146Foris, L. A., & Bhimji, S. S. (2017). Diabetic Gastroparesis. Treasure Island, FL: StatPearls Publishing. Gaitonde, S. (2019, March 4). Telephone interview.gender. 2018. In Merriam-Webster.com. Retrieved March 5, 2017. From https://www.merriam-webster.com/dictionary/gender

Green, S., Mason, K., & Krauss B. (2017). Pulmonary aspiration during procedural sedation: A comprehensive systematic review. British Journal of Anaesthesia. 118, 344-354. doi:10.1093/bja/aex004Gruenewald, T. L., Seeman, T. E.,

Karlamangla, A. S., & Sarkisian, C. A. (2009). Allostatic load and frailty in older adults. Journal of the American Geriatrics Society, 57, 1525-1531. doi:10.1111/j.1532-5415.2009.02389.xHall, J. E. (2016).

Guyton & Hall textbook of medical physiology (13th ed.). Philadelphia, PA: Elsevier. Hamada, S. R., Garcon, P., Ronot, M., Kerever, S., Paugam-Burtz, C., &

Mantz, J. (2014). Ultrasound assessment of gastric volume in critically ill patients. Intensive Care Medicine, 40, 965-972. doi:10.1007/s00134-014-3320-xHeitz, D., & Jewell, T. (2016). Gastric emptying scan. Retrieved from http://www.healthline.comHveem

, K., Jones, K. L., Chatterton, B. E., & Horowitz, M. (1996). Scintigraphic measurement of gastric emptying and ultrasonographic assessment of antral area: Relation to appetite. Gut, 38, 816-821. doi:10.1136/gut.38.6.816Imbelloni, L., Pombo, I., & Filho

, G. (2015). Reduced fasting time improves comfort and satisfaction of elderly patients undergoing anesthesia for hip fracture. Brazilian Journal of Anesthesiology, 65, 117-123. doi:10.1016/j.bjan.2013.10.017REFERENCES

Intagliata, N., & Koch, K. L. (2007). Gastroparesis in type 2 diabetes mellitus: Prevalence, etiology, diagnosis, and treatment. 

Current Gastroenterology Reports, 9, 270-279. doi:10.1007/s11894-007-0030-3Isono, S., Eikermann, M., &

Odaka

, T. (2014). Facemask ventilation during induction of anesthesia: How “gentle” is “gentle” enough?

Anesthesiology, 120

, 263-265. doi:10.1097/ALN.0000000000000095Janda, M., Scheeren, T. W., & Nöldge-Schomburg, G. F. (2006). Management of pulmonary aspiration. Best Practice & Research Clinical Anaesthesiology, 

20, 409-427. doi:10.1016/j.bpa.2006.02.006Jellish, W., Kartha, V., Flunder, E., & Slogoff, S. (2005). Effect of metoclopramide on gastric fluid volumes in diabetic patients who have fasted before elective surgery.

Anesthesiology. 102, 904-909. Retrieved from http://anesthesiology.pubs.asahq.org/journal.aspx Juster, R. P., McEwen, B. S., & Lupien, S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. 

Neuroscience & Biobehavioral Reviews, 35, 2-16. doi:10.1016/j.neubiorev.2009.10.002Kassaian, S., Goodarzynejad

, H., Boroumand, M., Salarifar, M., Masoudkabir, F., Mohajeri-Tehrani, M., . . . Nematipour, E. (2012). Glycosylated hemoglobin (HbA1c) levels and clinical outcomes in diabetic patients following coronary artery stenting.

Cardiovascular Diabetology, 82(11), 1-10. doi:10.1186/1475-2840-11-82Kruisselbrink, R., Arzola, C., Endersby

, R., Tse, C., Chan, V., & Perlas, A. (2014). Intra-and interrater reliability of ultrasound assessment of gastric volume. Journal of the American Society of Anesthesiologists, 121, 46-51. doi:10.1097/ALN.0000000000000193Kruisselbrink

, R., Arzola, C., Jackson., T., Okrainec, A., Chan, V., & Perlas, A. (2017). Ultrasound assessment of gastric volume in severly obese individuals: A validation study. British Journal of Anaesthesia, 118, 77-82. doi:10.1093/bja/aew400Liu, J. D. (2017). Preoperative anxiety’s incidence and related factors in surgical patients.

Clinical Trials. Retrieved from https://clinicaltrials.govMaltby, J. R. (2006). Fasting from midnight-the history behind the dogma. Best Practice & Research Clinical Anaesthesiology. 20, 363-378. doi:10.1016/j.bpa.2006.02.001Marik

, P. E. (2001). Aspiration pneumonitis and aspiration pneumonia. New England Journal of Medicine, 344(9), 665-671. doi:10.1056/NEJM200103013440908McEwen, B. (1998). Protective and damaging effects of stress mediators. The New England Journal of Medicine. 338. 171-179.

doi: 10.1056/NEJM199801153380307 McEwen, B. (2005). Stressed or stressed out: What is the difference? Journal of Psychiatry & Neuroscience. 30, 315-318. doi:10.1037/0278-6133.7.2.113McEwen, B. S., & Wingfield, J. C. (2010). What’s in a name? Integrating homeostasis, allostasis

and stress. Hormones and Behavior, 57, 105-111. doi:10.1016/j.yhbeh.2009.09.011MDSave. (2019). Gastrointestinal nuclear scan. Retrieved from https://www.mdsave.comMendelson, C. L. (1946). The aspiration of stomach contents into the lungs during obstetric anesthesia. Anesthesiology, 7, 694-695. doi:10.1097/00000543-194611000-00040Moldovan, C.,

Dumitrascu, D. L., Demian, L., Brisc, C., Vâtcã, L., & Magheru, S. (2005). Gastroparesis in diabetes mellitus: An ultrasonographic

study. Romanian Journal of Gastroenterology, 14, 19-22. Retrieved from http://www.jgld.roNagelhout, J. (2017). Nurse anesthesia (6th ed.). St. Louis, MO: Elsevier. Nakajima, K. (2017). Low serum amylase and obesity, diabetes, and metabolic syndrome: A

novel interpretation. World Journal of Diabetes, 7, 112-121. doi:10.4239/wjd.v7.i6.112

REFERENCES

Nanavari, A., & Prabhakar

, S. (2016). Enhanced recovery after surgery: If you are not implementing it, why not? Practical Gastroenterology. Retrieved from https://med.virginia.eduNater, U. M., &

Rohleder

, N. (2009). Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: current state of research. 

Psychoneuroendocrinology

, 34, 486-496. doi:10.1016/j.psyneuen.2009.01.014Ng, A., & Smith, G. (2001). Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesthesia & Analgesia, 93, 494-513. doi:10.1097/00000539-200108000-00050

Palermo, N. E., Gianchandani, R. Y., McDonnell, M. E., & Alexanian. (2016). Stress hyperglycemia during surgery and anesthesia: Pathogenesis and clinical implications. Current Diabetes Reports,16, doi:10.1007/s11892-016-0721-yPanchbhai, A.,

Degwekar, S., & Bhowte, R. (2010). Estimation of salivary glucose, salivary amylase, salivary total protein and salivary flow rate in diabetics in India. Journal of Oral Science, 52, 359-368. doi:10.2334/josnusd.52.359Perlas

, A., Chan, V. W., Lupu, C. M., Mitsakakis, N., & Hanbidge, A. (2009). Ultrasound assessment of gastric content and volume. Journal of the American Society of Anesthesiologists,

111, 82-89. doi:10.1097/ALN.0b013e3181a97250Perlas, A., Davis, L., Khan, M., Mitsakakis, N., & Chan, V. W. (2011). Gastric sonography in the fasted surgical patient: A prospective descriptive study. Anesthesia & Analgesia, 113

, 93-97. doi:10.1213/ANE.0b013e31821b98c0Perlas, A., Mitsakakis, N., Liu, L., Cino, M., Haldipur, N., Davis, L., & Chan, V. (2013). Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. 

Anesthesia & Analgesia, 116, 357-363. doi:10.1213/ANE.0b013e318274fc19Petrakova, L., Doering, B. K., Vits

, S., Engler, H., Rief, W., Schedlowski, M., & Grigoleit, J. S. (2015). Psychosocial stress increases salivary alpha-amylase activity independently from plasma noradrenaline levels. PloS One, 10. doi:10.1371/journal.pone.0134561Phillips, S., Liang, S., Formaz-Preston, A., & Stewart, P. (2015). High-risk residual gastric content in fasted patients undergoing gastrointestinal endoscopy: A prospective cohort study of prevalence and predictors.

Anaesthesia Intensive Care, 43, 728-733. doi:10.1177/0310057X150430061Pop-Busui, R. (2010). Cardiac autonomic neuropathy in diabetes: A clinical perspective. Diabetes Care, 33, 434-441. doi:10.2337/dc09-1294

Putte, V., & Perlas, A. (2014). Ultrasound assessment of gastric content and volume. British Journal of Anaesthesia, 113

, 12-22. doi:10.1093/bja/aeu151Raghavendran, K., Nemzek, J., Napolitano, L. M., & Knight, P. R. (2011). Aspiration-induced lung injury. Critical Care Medicine, 

39, 818-826. doi:10.1097/CCM.0b013e31820a856bRamachandran, S. K., & Kumar, A. M. (2014). Supraglottic airway devices. Respiratory Care, 59, 920-932. doi:10.4187/respcare.02976Robinson, M., & Davidson, A. (2014). Aspiration under anaesthesia

: Risk assessment and decision-making. Continuing Education in Anaesthesia, Critical Care & Pain, 14(4), 171-175. doi:10.1093/bjaceaccp/mkt053Robles, T. F., Sharma, R., Park, K. S., Harrell, L., Yamaguchi, M., & Shetty, V. (2012). Utility of a salivary biosensor for objective assessment of surgery-related stress. 

Journal of Oral and Maxillofacial Surgery, 70, 2256-2263. doi:10.1016/j.joms.2012.03.005Rosenberg, M., Phero, J., Becker, D. (2014). Essentials of airway management, oxygenation, and ventilation: part 2: advanced airway devices: supraglottic airways.

Anesthesia Progress, 62, 113-118. doi:10.2344/0003-3006-61.3.113Sadi, H., Finkelman, M., & Rosenberg, M. (2013). Salivary cortisol, salivary alpha amylase, and dental anxiety scale. Anesthesia Progress, 60

, 46-53. doi:10.2344/0003-3006-60.2.46Salem, M. R., Khorasani, A., Zeidan, A., & Crystal, G. J. (2017). Cricoid pressure controversies narrative review. 

Anesthesiology: Journal of the American Society of Anesthesiologists, 126, 738-752. doi:10.1097/ALN.0000000000001489Salimetrics. (2017). Salivary a-amylase: Kinetic enzyme assay kit. Retrieved from https://www.salimetrics.comSelye, H. (1951). The general-adaptation-syndrome. Annual Review of Medicine, 2, 327-342. doi:10.1146/annurev.me.02.02151.001551Sim, Y. B., Park, S. H., Kang, Y. J., Lee, J-K., Jung, J. S., & Suh, H. W. (2010). The regulation of blood glucose level in physical and emotional stress models: possible involvement of adrenergic and glucocorticoid systems. Archives of Pharmacal

Research.

33

, 1679-1683. doi:10.1007/s12272-010-1018-3

REFERENCES

Søreide

, E., Eriksson, L. I., Hirlekar, G., Eriksson, H., Henneberg, S. W., Sandin, R., & Raeder, J. (2005). Pre‐operative fasting guidelines: an update. Acta

Anaesthesiologica

Scandinavica, 

49, 1041-1047. doi:10.111/j.1399-6576.2005.00781.xSøreide, E., Holst-Larsen, H., Reite, K., Mikkelsen, H., Søreide, J. A., & Steen, P. A. (1993). Effects of giving water 20-450 ml with oral diazepam premedication 1-2 h before operative.

British Journal of Anaesthesia, 71, 503-506. doi:10.1093/bja/71.4.503Srinivas-Shankar, U., Somauroo, J. D.,

Delduca, A. M., Jordan, T. S., Bowles, S. A., & Rutter, M. K. (2008). Temporal change in glucose tolerance in non-ST-elevation myocardial infarction. Diabetes Research and Clinical Practice, 82, 310-316. doi:10.1016/j.diabres.2008.08.016Stach, O., Starczewska

, M., & Kanski. (2014). Usability of ultrasound assessment of gastric content: Case reports. Journal of Ultrasonography, 14, 442-446. doi:10.15557/JoU.2014.0047Sterling, P. (2012). Allostasis

: A model of predictive regulation. Physiology & Behavior. 106, 5-15. doi:10.1016/j.physbeh.2011.06.004Sterling, P., & Eyer, J. (1988). Handbook of life stress: Cognition and health. New York, NY: Wiley.

Thoma, M. V., Kirschbaum, C., Wolf, J. M., & Rohleder, N. (2012). Acute stress responses in salivary alpha-amylase predict increases of plasma norepinephrine. Biological Psychology,

91, 342-348. doi:10.1016/j.biopsycho.2012.07.008Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002). Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. 

Journal of Clinical Endocrinology & Metabolism, 87, 978-982.Walker, H., Thorn, C., Omundsen, M. (2006). Patients’ understanding of preoperative fasting. Anaesthesia and Intensive Care. 34, 358-361. doi:10.1177/0310057X0603400317Wetsch, W. A., Pircher, I., Lederer, W., Kinzl, J. F.,

Traweger, C., Heinz-Erian, P., & Benzer, A. (2009). Preoperative stress and anxiety in day-care patients and inpatients undergoing fast-track surgery. British Journal of Anaesthesia, 103, 199-205. doi:10.1093/

bja/aep136Willett, S., & Lee, F. (2018). Patient satisfaction and leadership challenge in the healthcare industry. Journal of the International Academy for Case Studies, 24(3). Retrieved from http://abacademies.orgYamaguchi, M., Takeda, K., Onishi, M.,

Deguchi, M., & Hugashi, T. (2006). Non-verbal communication method based on a biochemical marker for people with severe motor and intellectual disabilities. Journal of International Medical Research, 34, 30-41. Retrieved from http://imr.sagepub.com/content/34/1/30.full.pdf+html

REFERENCES

Thank You! Questions?