Anesthesiologists may encounter patients with unknown prandial status, and even fasting ��sufficient�� time cannot guarantee an empty stomach in many cases (e.g., in the elderly or in patients with gastroparesis). selleck chem Crenolanib Ultrasound can help in this setting, and the perioperative evaluation of bowel motility is also feasible by means of sonography. Current and potential applications of Gastric ultrasound are as follows: assessment of gastric content and diagnosis of full stomach;confirmation of gastric tube placement.Bouvet et al. [80], measured the antral cross-sectional area (CSA) in 180 patients after intubation and analyzed the relationship between antral CSA and the volume of gastric contents. The cut-off value of antral CSA of 340mm2 for the diagnosis of ��at risk�� stomach was associated with a sensitivity of 91% and a specificity of 71%.
The area under the receiver operating characteristic (ROC) curve for the diagnosis of ��at-risk�� stomach was 90%. (��At risk�� stomach was defined as the presence of solid particles and/or gastric fluid volume more than 0.8mL/kg.) These findings show that antral CSA volume assessment can be important in minimizing the risk of pulmonary aspiration of gastric contents. Perlas et al. [81] performed gastric sonography in 86 patients before anesthetic induction, and patients were classified using a 3-point grading system; grade 0 (empty antrum); grade 1 (minimal fluid volume detected only in the right lateral decubitus position (16 +/? 36mL, within normal ranges expected for fasted patients); and grade 2 (antrum clearly distended with fluid visible in both supine and lateral positions (180 +/? 83mL, beyond previously reported ��safe�� limits).
One patient with a grade 2 antrum had an episode of a significant regurgitation of gastric contents on emergence from anesthesia. They concluded that this grading system could be a promising ��biomarker�� to assess perioperative aspiration risk. Perlas et al. [82], in another work, validated a mathematical model for quantitative US assessment of gastric volume. Arzola et al. [83] found that anesthesiologists will achieve a 95% success rate in bedside qualitative ultrasound assessment after performing approximately 33 examinations, with appropriate training and supervision.
Confirmation of a gastric tube placement is also possible using ultrasound
Natural polysaccharides and their derivatives are extensively used in pharmaceutical and food industry as biodegradable and biocompatible polymers for a large number of applications Drug_discovery such as binding, thickening, emulsifying, and gelling and as controlled release agents. Psyllium is one such polysaccharide which has been used since times immemorial as a dietary supplement to promote the regulation of bowel movement. Psyllium also known as is paghula is comprised of seed husks of Plantago ovata Forsk (family Plantaginaceae).