Careful once, safe once, a real case on the importance of CT scan before anesthesia

Recently, we encountered a patient who required emergency appendicitis surgery. The patient was a 61-year-old male who was admitted to the right internal medicine department at 9:48 am due to "right lower abdominal pain for 1 day". After physical examination and related auxiliary examinations, it was confirmed that he had acute appendicitis and was transferred to surgical treatment at 12:10.

When visiting the patient before anesthesia, we checked the patient's abdominal CT at 10 am and chest CT at 2 pm and found a large amount of stomach contents, and the stomach filling degree did not change much after 4 hours. When asked, the patient said that he had not eaten or drunk anything since 9 pm the night before. This patient obviously had gastric retention, and the anesthesia plan must be formulated according to a full stomach. I am afraid and want to express my feelings here!

Preoperative anesthesia assessment is one of the key links to ensure the safety of surgery. However, the assessment of whether the stomach is full is particularly important, and abdominal CT examination plays a vital role in this process.

First, when the patient ingests food or liquids before surgery and the stomach is full, the patient is in a state of fullness. There are also cases of delayed gastric emptying or pyloric obstruction causing gastric retention. Anesthesia under these conditions has a higher risk of reflux aspiration. Abdominal CT can provide anesthesiologists with intuitive gastric image information.

CT scans can clearly show the size and shape of the stomach, as well as the amount of food and liquid in the stomach. This helps doctors accurately assess the possibility of reflux and aspiration during anesthesia. If there is a large amount of food or liquid in the stomach, then once reflux occurs during anesthesia, these gastric contents may enter the respiratory tract, causing serious lung complications and even endangering life. In this case, anesthesiologists need to be more cautious in choosing anesthesia methods and drugs to reduce risks.

At the same time, abdominal CT examination results can also provide important reference for the surgical team. According to the specific situation of the stomach, the surgeon can adjust the surgical plan and schedule to ensure the smooth progress of the operation.

Of course, there are many ways to assess whether the stomach is full: asking about the time of eating and drinking, whether there is a history of gastric disease, whether there is a history of diabetes, etc., and the ultrasound assessment method is currently more popular. However, the departments involved need to be equipped with ultrasound equipment, anesthesiologists need to master ultrasound operation techniques, and restrictions such as medical insurance charges have not yet been promoted in grassroots hospitals. Instead, when evaluating the patient, you can take a look at the CT image data, combined with the patient's eating and drinking situation, and it will be clear at once (in most cases, the CT report will not report the stomach condition unless the doctor requires it).

In short, anesthesiologists should not forget to look at the lower abdominal CT gastric imaging data before surgery, especially during emergency surgery! What other good methods do you have for assessing whether the stomach is full? Welcome to discuss in the comment section.

Xu Bing, Department of Anesthesiology, Qionglai Second People's Hospital, Sichuan Province

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