Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound

Sabry, Rabab; Hasanin, Ahmed; Refaat, Sherin; Raouf, Sabah Abd El; Abdallah, Ahmed; Helmy, Nadia

doi:10.1111/aas.13315

Cited by 37 publications

(41 citation statements)

References 22 publications

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“…Patient pathology, particularly concomitant diabetes, theoretically may contribute to increased risk of delayed gastric emptying. 130 In addition, this topic generally is unstudied in the setting of transesophageal echocardiography, which may contribute to the risk of aspiration. From a practical standpoint, cardiac surgical times can be unpredictable, and even elective schedules are dynamic, which may complicate the implementation of shorter NPO timelines.…”

Section: Continued Consumption Of Clear Liquids Until 2 Tomentioning

confidence: 99%

Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step—But There Is Much Work to Be Done

Gregory

Grant²,

Manning

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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ENHANCED RECOVERY After Surgery (ERAS) is an international effort to develop perioperative programs aimed at optimizing patient outcomes and healthcare delivery efficiency. These programs are composed of intervention bundles based on the principles of best practice, standardized and consistent healthcare delivery, regular audit, and team feedback, all with a patient-centered focus. Implementation of such programs has resulted in patient and healthcare benefits, including promising early results within the cardiac surgical community. [1][2][3][4] There have been recent concerns that old dogma, typically rooted in clinical anecdotes and minimal peer-reviewed evidence, will be replaced with new dogma under the umbrella of "enhanced recovery" without validation in cardiac surgical patients. 5 An imprudent "changing of the guard" is a justifiable concern with any practice update. Gathering current evidence-based best practices was a key motivation for the creation of the original colorectal ERAS protocol.The Society for Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) recently published "Guidelines for Perioperative Care in Cardiac Surgery" based on a systematic review and multidisciplinary consensus. 6 Twenty-two recommendations were graded according to currently accepted standards for level of evidence (LOE) and confidence of recommendation (COR) (Table 1). 7,8 The authors of this editorial represent the current anesthesiologist membership of the ERAS Cardiac Society. We have chosen a subset of the recommendations to discuss, including why each is important for patients during their recovery and which future steps are required to solidify the supporting evidence for each recommendation.

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Section: Continued Consumption Of Clear Liquids Until 2 Tomentioning

confidence: 99%

Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step—But There Is Much Work to Be Done

Gregory

Grant²,

Manning

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Previous studies have reported the use of ultrasound imaging preoperatively for bedside assessment of gastric content and volume in non-fasting, diabetic, severely obese, and intensive care patients (8)(9)(10). Sayyadi et al (9).…”

Section: Introductionmentioning

confidence: 99%

Gastric Residual Volume Assessment by Gastric Ultrasound in Fasting Obese Patients: A Comparative Study

et al. 2021

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Background: Gastric ultrasound is an emerging tool for preoperative evaluation of gastric content and volume. Objectives: To assess gastric residual volume in normal-weight and obese patients scheduled for elective surgery. Methods: This prospective observational study was conducted on 100 patients assigned to two groups of 50 patients each. The obese group included patients with body mass index (BMI) of 30 - 40 and American Society of Anesthesiologists (ASA) grade II and those with BMI > 40 and ASA III without other comorbidities; the normal-weight group included patients with normal BMI and ASA I. Gastric volume was predicted in each group using sonographic measurement of antral cross-sectional area (CSA) in semi-sitting and right lateral positions (RLP); the two groups were compared to assess the risk of aspiration for each group preoperatively. Results: Despite intergroup differences in antral CSA, the sonographically predicted gastric volume was < 1.5 mL/kg in both groups in both positions. Both groups were at a low risk for aspiration, and 98% of the patients showed grade 0 or 1 in antrum assessments, corresponding to an empty antrum and minimal fluid only in the RLP, respectively. Only 2% of the patients in both groups showed a distended antrum in both positions. Conclusions: Despite the differences in CSA between obese and normal-weight participants in both positions (obese > normal-weight), both groups showed a low predicted gastric residual volume < 1.5 mL/kg and were at low risk for aspiration, provided that fasting was initiated at least 8 hours before elective surgery.

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“…Bouvet et al (2017) reported the prevalence of the full stomach in 56% of emergency surgery patients and suggested that preoperative ultrasound assessment of gastric contents may be particularly helpful in this case [4]. Sabry et al (2019) demonstrated that gastric ultrasound is used as a reliable method to assess the residual gastric volume in fasting diabetics compared to the healthy control for elective surgery and reported that the residual gastric volume in diabetic patients fasting for 8 hours was higher than in patients without diabetes scheduled for elective surgery [10].…”

Section: Resultsmentioning

confidence: 96%

“…Based on a study done by Sabry et al, [10] to show a difference in the incidence of change of aspiration risk after gastric ultrasonographic assessment in comparison to clinical assessment with a con dence interval at 95% and the acceptable margin of error at 5%. The p-value was considered signi cant if < 0.05 and needed minimally a sample size of 45 patients.…”

Section: Sample Size Calculationmentioning

confidence: 99%

Routine Point of Care Ultrasound (POCUS) Assessment of Gastric Antral Contents in Traumatic Emergency Surgical Patients for Prevention of Aspiration Pneumonitis: A Randomized Clinical Trial 

Shorbagy

Kasem

Eldin

et al. 2020

Preprint

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Background: Polytrauma patients are at a higher risk of delayed gastric emptying. To assess gastric volume, a reliable diagnostic tool is needed to prevent the occurrence of aspiration pneumonia, which remains a serious complication associated with anesthesia. Gastric antral ultrasound can provide reliable information about the size of the gastric antrum in traumatized patients undergoing emergency surgery.Methods: A prospective observational study of 45 polytrauma patients undergoing emergency surgery under general anesthesia. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed to allow qualitative and quantitative assessment of gastric antrum in a supine position and right lateral decubitus (RLD) position. Followed by routine placement of nasogastric tube to aspirate and calculate the volume of the stomach contents.Results: Forty-five polytrauma patients who underwent gastric ultrasound examination showed that the risk assessment of aspiration and anesthesia technique changed in 14 patients (31.1%) after the ultrasound examination.A very good relationship existed between the expected stomach volume at the RLD position and the suction volume in the nasogastric tube. In all cases, no aspirations were documented.Conclusion: Ultrasound examination of the stomach in polytrauma patients allows assessing the size and type of stomach contents. The data obtained can influence the choice of anesthesia technique while inducing anesthesia and reduce the risk of aspiration pneumonia.Trial registration: This trial was registered at ClinicalTrials.gov. Registry number: NCT04083677.

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Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound

Abstract: The study was registered at clinicaltrials registry system with trial number: NCT 03438305. URL: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00 07SDV&selectaction=Edit&uid=U0002TST&ts=3&cx=ohgvvk.

Cited by 37 publications

References 22 publications

Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step—But There Is Much Work to Be Done

Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step—But There Is Much Work to Be Done

Gastric Residual Volume Assessment by Gastric Ultrasound in Fasting Obese Patients: A Comparative Study

Routine Point of Care Ultrasound (POCUS) Assessment of Gastric Antral Contents in Traumatic Emergency Surgical Patients for Prevention of Aspiration Pneumonitis: A Randomized Clinical Trial

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Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound

Abstract: The study was registered at clinicaltrials registry system with trial number: NCT 03438305. URL: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00 07SDV&selectaction=Edit&uid=U0002TST&ts=3&cx=ohgvvk.

Cited by 37 publications

References 22 publications

Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step—But There Is Much Work to Be Done

Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step—But There Is Much Work to Be Done

Gastric Residual Volume Assessment by Gastric Ultrasound in Fasting Obese Patients: A Comparative Study

Routine Point of Care Ultrasound (POCUS) Assessment of Gastric Antral Contents in Traumatic Emergency Surgical Patients for Prevention of Aspiration Pneumonitis: A Randomized Clinical Trial&nbsp;

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Routine Point of Care Ultrasound (POCUS) Assessment of Gastric Antral Contents in Traumatic Emergency Surgical Patients for Prevention of Aspiration Pneumonitis: A Randomized Clinical Trial