Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study

Abstract

Background Delayed gastric emptying and the resultant “full stomach” is the most important risk factor for perioperative pulmonary aspiration. Using point-of-care gastric sonography, we aimed to investigate the prevalence of full stomach and its risk factors in elective surgical patients with type 2 diabetes. Methods Type 2 diabetic and non-diabetic elective surgical patients were included from July 2017 to April 2018 in a 1:1 ratio. The study was retrospectively registered at July 2017, after enrollment of the first participant. Gastric ultrasound was performed 2 h after ingesting clear fluid or 6 h after a light meal. Full stomach was defined by the presence of gastric content in both semi-recumbent and right lateral decubitus positions. For patients with full or intermediate stomach, consecutive ultrasound scan was performed until empty stomach was detected. Logistic regression analyses were used to identify risk factors associated with full stomach. Results Fifty-two type 2 diabetic and fifty non-diabetic patients were analyzed. The prevalence of full stomach was 48.1% (25/52) in diabetic patients, with 44.0% for 2-h fast after clear fluid and 51.9% for 6-h fast after a light meal, significantly higher than 8% (4/50) in non-diabetic patients (P = 0.000). The average time to empty stomach in diabetic patients was 146.50 ± 40.91 mins for clear liquid and 426.50 ± 45.25 mins for light meal, respectively. Further analysis indicated that presence of diabetes-related eye disease was an independent risk factor of full stomach in diabetic patients (OR = 4.83, P = 0.010). Conclusions Almost half of type 2 diabetic patients have a full stomach following the current preoperative fasting guideline. Preoperative ultrasound assessment of gastric content in type 2 diabetic patients is suggested, especially for those with diabetes -related eye disease. Trial registration The trial was registered at www.clinicaltrials.gov with registration number NCT03217630. Retrospectively registered on 14th July 2017.

Assessment of residual gastric volume using point-of-care ultrasonography in adult patients who underwent elective surgery

“…Per univariate analysis, we found a statistically significant association between BMI ( p -value − 0.026*) and type 2 diabetes ( p -value − 0.045*) with antral grade. Our findings are consistent with the study conducted by Zhou et al, which was a prospective cohort study in 2017 where they included 52 type 2 diabetic and 50 non-diabetic patients posted for elective surgeries [ 16 ]. Patients in both groups were fasted overnight (at least 10 h) from the last meal.…”

“…Preoperative gastric ultrasound was performed 2 h after ingesting clear fluid or 6 h after a light meal. Authors found that type 2 diabetic patients (25/52; 48.1%) have a higher prevalence ( p = 0.000) of the full stomach when compared to non-diabetic patients (4/50; 8.00%) [ 16 ]. Bouvier et al conducted a study involving 440 patients undergoing elective or emergency surgery.…”

Perioperative pulmonary aspiration and regurgitation without aspiration in adults: a retrospective observational study of 166,491 anesthesia records

“…Patients with diabetes, especially diabetes-related autonomic neuropathy, retinopathy, and nephropathy, are at increased risk of delayed stomach emptying (19,20). Zhou et al recommended preoperative ultrasound assessment of gastric content for patients with diabetes duration ≥6 years, prokinetic drugs, and RSI (21).…”

Perioperative gastric ultrasound: utility and limitations

“…They also showed significantly longer gastric emptying times. The study also found diabetic retinopathy to be a risk factor for full stomach in type II diabetics after appropriate NPO time 38. In another study of those with risk factors for aspiration, 12% of diabetic patients were found to have solid food on gastric ultrasound despite following NPO guidelines 39.…”

“…While imaging all patients is not necessary, imaging obese patients, those with diabetes or chronic abdominal conditions would increase the likelihood of identifying at-risk patients. In an observational study by Zhou and colleagues, diabetic participants had an increased likelihood of having a full stomach versus nondiabetic patients 38. Two hours after ingesting clear liquids, 44% of diabetic subjects versus 8% of nondiabetic subjects had an exam consistent with elevated gastric volume.…”