Anaesthesia, critical care & pain medicine · 2026
Ultrasound measurement of antral cross-sectional area to predict regurgitation during general anesthesia for cesarean section in laboring women: a prospective observational cohort study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Shen Longyuan, Jiang Qiuxia, Yu Xiaojuan, Xiao Quansheng, Wang Shengzhao, Lin Xiongda, Luo Qichen, Huang Shaoqiang
Аннотация
BACKGROUND: Qualitative and quantitative ultrasonography can reliably differentiate between a full and empty stomach. However, no prior studies have correlated gastric volume with actual intraoperative regurgitation or aspiration events. This study investigated the relationship between ultrasonographically measured gastric antral cross-sectional area and the occurrence of regurgitation in parturients, to inform ultrasonographic diagnostic criteria for predicting regurgitation risk.
METHODS: Eighty parturients undergoing urgent cesarean section under general anesthesia were enrolled. Upon arrival in the operating room, patients were positioned in a semirecumbent position for gastric ultrasound assessment. Subsequently, an esophageal pH electrode was inserted nasally. After rapid sequential induction intubation, anesthesia was maintained with sevoflurane and nitrous oxide. Mid-esophageal pH was monitored in real time until 10 min after extubation to detect occult regurgitation. The receiver operating characteristic curve assessed the predictive ability of antral cross-sectional area for regurgitation in parturients; associations between potential covariates and regurgitation occurrence were assessed using multivariable logistic regression.
RESULTS: Regurgitation was observed in 34 parturients (one overt and 33 occult), with no cases of clinically significant aspiration occurring. The optimal antral cross-sectional area cut-off for predicting regurgitation was 487.7 mm2 (area under the receiver operating characteristic curve: 0.876; 95% confidence interval: 0.80-0.95). In addition to cross-sectional area, other independent risk factors included the interval from last clear fluid intake to surgery and the last oral intake after labor onset.
CONCLUSIONS: Antral cross-sectional area ≥487.7 mm2 accurately predicts occult regurgitation in urgent cesarean section under general anesthesia. Incorporating additional risk factors may improve risk stratification.
REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400090328).
METHODS: Eighty parturients undergoing urgent cesarean section under general anesthesia were enrolled. Upon arrival in the operating room, patients were positioned in a semirecumbent position for gastric ultrasound assessment. Subsequently, an esophageal pH electrode was inserted nasally. After rapid sequential induction intubation, anesthesia was maintained with sevoflurane and nitrous oxide. Mid-esophageal pH was monitored in real time until 10 min after extubation to detect occult regurgitation. The receiver operating characteristic curve assessed the predictive ability of antral cross-sectional area for regurgitation in parturients; associations between potential covariates and regurgitation occurrence were assessed using multivariable logistic regression.
RESULTS: Regurgitation was observed in 34 parturients (one overt and 33 occult), with no cases of clinically significant aspiration occurring. The optimal antral cross-sectional area cut-off for predicting regurgitation was 487.7 mm2 (area under the receiver operating characteristic curve: 0.876; 95% confidence interval: 0.80-0.95). In addition to cross-sectional area, other independent risk factors included the interval from last clear fluid intake to surgery and the last oral intake after labor onset.
CONCLUSIONS: Antral cross-sectional area ≥487.7 mm2 accurately predicts occult regurgitation in urgent cesarean section under general anesthesia. Incorporating additional risk factors may improve risk stratification.
REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400090328).