W. Boyan1, M. Jaronczyk1, M. Goldfarb1 1Monmouth Medical,Long Branch, NJ, USA
Introduction: Nausea and vomiting are a common complaint of the post operative patient. Many factors can lead to nausea ranging from distension of the stomach to medications. At our institution, over a five year period 12/13 patients who aspirated subsequently died. Nasogastric tubes are frequently used after a patient has an episode of emesis and sometimes as a prophylactic measure to decompress the stomach where ileus is suspected. Unfortunately no diagnostic means exists to determine whether nausea is due to gastric distension and ileus or medication related. In this pilot study the aim was to create a novel diagnostic measure, using bedside gastric ultrasound to differentiate the two distinct causes of post operative nausea. The first being due to gastric distension so that an NGT could be placed. The other being medication/pain related nausea not related to gastric distension and therefore no role for NGT decompression.
Methods: Our work was a prospective study of patients who underwent elective colorectal resections by two board-certified colorectal surgeons over a three month period. The patient’s stomach were examined with ultrasound on the day of operation after completing their bowel prep and being NPO after midnight. The measurement was taken in cm at its largest anterior-posterior diameter. The ultrasound was then repeated every morning as patients were asked about nausea and vomiting. Any reports of emesis were documented. NGT’s were placed on clinical reasoning and the ultrasound measurements were only recorded for purpose of the study.
Results:Twenty patients underwent elective colorectal surgery after bowel prep. The average size of the stomach at its largest anterior-posterior diameter measured 4.31 cm. Nausea was reported in five patients, three of these patients also reported vomiting and one of these had an NGT placed. In only one patient did the nausea or vomiting correlate with an increased gastric measurement of 5.1 and 8.0 cm; this was subsequently the patient who needed an NGT. This patient’s average gastric measurement was 4.48 cm over their six day hospital stay. The day this patient NGT was placed their measurement was 8cm which is greater than two standard deviations higher than the average, 1500 cc of bilious material was drained initially. The other four patients with complaints had measurements below the average for asymptomatic patients.
Conclusion: The goal of this pilot study was to develop a unique means of accurately measuring gastric distension to identify patients at risk of vomiting and aspiration. Although user dependent, ultrasound for gastric measurement can provide a novel means to differentiate nausea related to pain/medication to that caused by gastric distention. This differentiation will prove valuable when it leads to use of NGT to decompress the stomach, prevent vomiting and the disastrous potential complication of aspiration.