Abstract
BackgroundDelayed 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.MethodsType 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.ResultsFifty-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).ConclusionsAlmost 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 registrationThe trial was registered at www.clinicaltrials.gov with registration number NCT03217630. Retrospectively registered on 14th July 2017.
Highlights
Gastric emptying is known to be delayed in patients with diabetes mellitus [1, 2]
There were no significant differences in age, sex, American Society of Anesthesiologists (ASA) physical status and body mass index (BMI) between diabetic and nondiabetic patients, except that the Self-Rating Anxiety Scale (SAS) scores were higher in diabetic patients, whereas both were lower than 40 (SAS score anxiety≥40 defined as anxiety) [23]
Sex, BMI and SAS scores, diabetes-related eye disease was shown to be an independent risk factor of full stomach (Table 4). This prospective study showed that almost half of the type 2 diabetic patients with a median duration of 6 years had a full stomach following the current preoperative fasting guideline, and the average time to empty stomach state for diabetic patients is 146.50 ± 40.91 mins for clear liquids and 426.50 ± 45.25 mins for light meal, longer than the recommended fasting duration of ASA [5]
Summary
Gastric emptying is known to be delayed in patients with diabetes mellitus [1, 2]. Approximately 30–50% of patients with longstanding diabetes mellitus have significantly prolonged gastric emptying time, as measured by radioisotope examination [3, 4]. Delayed gastric emptying and the resultant “full stomach” is the most important risk factor for perioperative regurgitation and aspiration, which remains a common, disastrous complication with high morbidity and mortality in patients undergoing general anesthesia. American Society of Anesthesiologists (ASA) released preoperative fasting guidelines for healthy patients undergoing elective surgery [5], in order to reduce gastric content volume and minimize the risk of aspiration. We hypothesize that ultrasound sonography will be helpful to determine the gastric content in elective surgical patients with type 2 diabetes mellitus. 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
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