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 2h after ingesting clear fluid or 6h 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-hour fast after clear fluid and 51.9% for 6-hour 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. Key words : type 2 diabetes mellitus; gastric emptying; regurgitation and aspiration; ultrasonography

Gastric content and perioperative pulmonary aspiration in patients with diabetes mellitus: a scoping review

“…19e34 No studies were found whose primary outcome was to report the incidence of aspiration in surgical patients with DM, nine articles studied gastric emptying, [19][20][21][22][23][24][25][26][27] and seven reported gastric content or volume. [28][29][30][31][32][33][34] Fig. 1 shows the flow chart of articles through the scoping review, with reasons for exclusions.…”

“…2,17,18 Recently, several observational studies have investigated gastric emptying and fasting residual volumes in subjects with DM. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] This scoping review was undertaken to explore the breadth of the literature concerning the aspiration risk for surgical patients with DM and help identify knowledge gaps that may require further study. Ultimately, the knowledge gained by this review and the results of further studies can help inform evidence-based medicine and clinical guidelines to minimise aspiration risk in patients with DM.…”

“…41 In total, seven studies compared fasting gastric content or volume of patients with and without DM scheduled for elective surgery (Table 3). [28][29][30][31][32][33][34] Of these, four studies exclusively assessed gastric content/volume in patients undergoing preoperative fasting through bedside USG. [28][29][30][31] Two other studies determined gastric volume by aspirating gastric contents via a nasogastric (NG) tube after induction of anaesthesia and endotracheal intubation.…”

“…[28][29][30][31][32][33][34] Of these, four studies exclusively assessed gastric content/volume in patients undergoing preoperative fasting through bedside USG. [28][29][30][31] Two other studies determined gastric volume by aspirating gastric contents via a nasogastric (NG) tube after induction of anaesthesia and endotracheal intubation. 32 33 Lastly, one study examined patients preoperatively using USG and confirmed findings by aspiration of the gastric content after induction of anaesthesia.…”

“…34 All studies were performed in a university hospital setting. [28][29][30][31][32][33][34] Common exclusion criteria included patients <18 yr, pregnant women, ASA score 4, BMI >40 kg m À2 , and patients with gastric intestinal tract diseases that could confound the results. In four studies, the person who performed the USG scanning was blinded to the patient's DM status.…”