Sonographic gastric content evaluation in patients undergoing cataract surgery

Perioperative pulmonary aspiration of gastric contents is a serious complication and causes mortality and morbidity. The study aimed to assess the gastric content of patients undergoing cataract surgery by performing bedside ultrasonography. The secondary aim was to conduct a survey of hospital staff about fasting for cataract surgery.

This single-center, cross-sectional study included 65 patients who underwent cataract surgery. The quantitative and qualitative measurements of the gastric content and antral area were performed by gastric ultrasonography in the right lateral decubitus position. The incidence of risk to the stomach was defined according to different threshold levels: content >0.8 ml/kg and 1.5 ml/kg and cross-sectional antral area >340 mm². A questionnaire was provided to anesthesiologists and ophthalmologists about fasting for cataract surgery.

The mean age was 69.48 ± 11.10 years. The mean gastric antrum cross-sectional area (CSA) was 11.08 ± 6.42 cm². The predicted gastric volume was 103.39 ± 94.79 ml and 1.37 ± 1.20 ml/kg. The antral area CSA and gastric volume/kg decreased as the fasting time increased. About 98.5% of the patients exceeded the high-risk stomach antral cut-off CSA defined as 340 mm². Gastric content exceeded 0.8 ml/kg in 58.33% of patients and exceeded 1.5 ml/kg in 41.67% of patients. Gastric content in patients was found to be 65.0% solid, 20.0% liquid, and 15.0% empty. All seven ophthalmologists did not apply fasting protocols for cataract surgery.

Point of care ultrasonography is a useful, noninvasive tool in determining gastric content and volume. As majority of the patients presented with a full stomach for cataract surgery, we recommend that ophthalmologists and anesthesiologists follow preoperative fasting guidelines for cataract surgery.