Research Article

Cross-Sectional Study to Compare Preoperative Fasting Volume of Gastric Contents by Using Ultrasonography in Non-Diabetic and Diabetic Patients Posted for Elective Surgery

Abstract

Background: Diabetic patients are known to have gastroparesis and consequent delayed gastric emptying which predisposes them to an increased risk of aspiration as compared to the general population. This study compares the gastric volumes in diabetic and non-diabetic patients using point-of-care ultrasound and correlates it with the HbA1c levels in diabetic patients.
Methods: This cross-sectional study included 180 patients, 90 diabetic (>5 years) and 90 nondiabetic, aged >40 years, American Society of Anaesthesiologists' physical status I–II kept fasting for 8 hours. Before induction, gastric ultrasound was performed to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross-sectional area (CSA) and gastric volume (GV) in right lateral decubitus (RLD) position using curved array probe. In diabetic patients, the gastric volumes were correlated with HbA1c values.
Results: In the RLD, the mean CC and AP diameters were higher in diabetic Group. The calculated CSA in RLD in diabetics (8.014 ± 2.412 cm2) were significantly higher than non-diabetic (6.314± 2.894 cm2) (p < 0.0001). The calculated GV of 71.501 ± 35.937 ml in the diabetic group was significantly higher than 48.0022± 41.587 ml in the non-diabetic group (p < 0.0001). In diabetics, the gastric volumes showed significant correlation with HbA1c.
Conclusion: Diabetic patients show higher residual gastric volume as compared to non-diabetic patients indicating gastroparesis. The gastric volumes are further increased in those with poorly controlled disease with high HbA1C levels. Ultrasound is an effective tool in assessing the risk of aspiration and altering anaesthetic management accordingly.

[1] Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001; 93(2):494-513.
[2] Hveem K, Hausken T, Berstad A. Ultrasonographic assessment of fasting liquid content in the human stomach. Scand J Gastroenterol. 1994; 29(9):786-9.
[3] Darwiche G, Almér LO, Björgell O, Cederholm C, Nilsson P. Measurement of gastric emptying by standardized real‐time ultrasonography in healthy subjects and diabetic patients. J Ultrasound Med. 1999; 18(10):673-82.
[4] Bouvet L, Mazoit JX, Chassard D, Allaouchiche B, Boselli E, Benhamou D. Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume. Anesthesiology. 2011; 114(5):1086-92.
[5] Perlas A, Davis L, Khan M, Mitsakakis N, Chan VW. Gastric sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg. 2011; 113(1):93-7.
[6] Cubillos J, Tse C, Chan VW, Perlas A. Bedside ultrasound assessment of gastric content: an observational study. Can J Anaesth. 2012; 59(4):416-23.
[7] Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014; 113:12-22.
[8] Perlas A, Mitsakakis N, Liu L, Cino M, Haldipur N, Davis L, et al. Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesth Analg. 2013; 116:357-63.
[9] Horowitz M, O'Donovan D, Jones KL, Feinle C, Rayner CK, Samsom M. Gastric emptying in diabetes: clinical significance and treatment. Diabet Med. 2002; 19(3):177-94.
[10] Horowitz M, Wishart JM, Jones KL, Hebbard GS. Gastric emptying in diabetes: an overview. Diabet Med. 1996; 13(9 Suppl 5):S16-22.
[11] Kong MF, Macdonald IA, Tattersall RB. Gastric emptying in diabetes. Diabet Med. 1996; 13(2):112-9.
[12] Garg H, Podder S, Bala I, Gulati A. Comparison of fasting gastric volume using ultrasound in diabetic and non diabetic patients in elective surgery: An observational study. Indian J Anaesth. 2020; 64:391-6.
[13] Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009; 111(1):82-9.
[14] Schmitz A, Schmitz A, Schmitz A, Schmitz A, Thomas S, Melanie F, et al. Ultrasonographic gastric antral area and gastric contents volume in children. Paediatr Anaesth. 2012; 22(2):144-9.
[15] Haramgatti A, Sharma S, Kumar A, Jilowa S. Comparison of ultrasound-guided residual gastric volume measurement between diabetic and non-diabetic patients scheduled for elective surgery under general anesthesia. Saudi J Anaesth. 2022; 16(3):355-60.
[16] Ewing DJ, Clarke BF: Diabetic autonomic neuropathy: a clinical viewpoint. In Diabetic Neuropathy Dyck PJ, Thomas PK, Asbury AK, Weingrad AI, Porte D, Eds. Philadelphia, WB Saunders,1987;66–88.
Files
IssueVol 10 No 2 (2024): Spring QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v10i2.15062
Keywords
point-of-care gastric ultrasound glycosylated haemoglobin fasting gastric volume
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Kenchey K, Swami S, Patil K. Cross-Sectional Study to Compare Preoperative Fasting Volume of Gastric Contents by Using Ultrasonography in Non-Diabetic and Diabetic Patients Posted for Elective Surgery. Arch Anesth & Crit Care. 2023;10(2):143-147.