Abdominal point-of-care ultrasound before anesthesia in a patient with an unstable C-spine.

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Date: Sept. 26, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 37)
Publisher: CMA Impact Inc.
Document Type: Article
Length: 723 words
Lexile Measure: 1890L

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We prepared to anesthetize an 83-year-old, 75-kg man with an unstable cervical vertebra 5 (C5) spine fracture for a posterior cervical decompression and fusion. He was neurologically intact, wearing a hard cervical collar, and had fasted for more than 12 hours. Assuming an "empty" stomach, we planned to intubate using an asleep fibre optic technique to minimize neck movement during airway manipulation. However, during the preoperative evaluation, the patient reported nausea.

We performed a gastric ultrasound examination using a previously described protocol. (1) We used a Sonosite Edge portable ultrasound unit and a curvilinear transducer to identify the antrum in a sagittal plane in the epigastric area. The patient's antrum appeared grossly distended with hypoechoic fluid content in both supine and right lateral decubitus positions (Grade 2 antrum) (1) with an estimated volume of more than 400 mL (Figure 1-I and Appendix 1, supplementary video 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.220525/tab -related-content). We drained 450 mL of fluid from his stomach using a nasogastric tube. Repeat examination confirmed an "empty stomach" (Grade 0 antrum) with an estimated volume of 10 mL (Figure...

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Gale Document Number: GALE|A719029249