Gastric Antral Cross-sectional Area Research Articles

STUDY TO COMPARE FASTING GASTRIC VOLUME USING ULTRASOUND IN DIABETIC AND NON DIABETIC PATIENTS POSTED FOR ELECTIVE SURGERIES

Objective: To study the comparison of fasting gastric volume using ultrasound in diabetic and nondiabetic patients in elective surgeries. To compare the incidence of delayed gastric emptying in diabetic and nondiabetic after standard fasting guidelines Material and Methods: After institutional ethical committee approval, CTRI registration and patient consent, prospective study was conducted in 30 diabetic and 30 non-diabetic patients aged 30-60years of American society of anesthesiologists- physical status I-III having similar fasting intervals. Pre operatively, quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed using curvilinear probe in accordance to standard gastric scanning. USG grade, cross-sectional area (CSA) of the antrum and gastric volume were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively. Results:The CSA of 2.35 ± 1.07 cm2 and 3.51 ± 1.4 cm2 in diabetic were significantly higher (P = 0.001) than 1.37 ± 0.32 cm2 and 2.19 ± 1.15 cm2 of control, in supine and RLD positions, respectively. GV was 3.85± 20.06 ml in control group and 6.5±23.51 ml in diabetic group. Conclusion: Diabetic patients have higher gastric antral cross-sectional area and gastric volumes as observed by gastric ultrasound than the non-diabetic patients. Reference - 1. Robinson M, Davidson A. Aspiration under anaesthesia: Risk assessment and decision-making. Contin Edu Anaesth Crit Care Pain. 201314:171–5. 2.Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009111:82–9. 3. Smith I, Kranke P, Murat I, Smith A, OSullivan G, Soreide E, et al. Perioperative fasting in adults and children: Guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 201128:556–69.

Point-of-Care Ultrasound for Gastric Volume Measurement in a Pediatric Patient-Look Beyond the Antrum: A Case Report.

Gastric ultrasound estimates stomach contents in perioperative patients. A 10-year-old boy with abdominal rhabdomyosarcoma, who received abdominal radiation, developed gastroparesis and was scheduled for endoscopic gastrointestinal pyloric dilation. Point-of-care gastric ultrasound revealed gastric antral cross-sectional area of 6.5 cm2 (estimated gastric content ~30 mL). However, dynamic right-to-left ultrasound revealed more hypoechoic material in the fundus of the stomach. On induction ~125 mL of stomach contents was suctioned. Antral measurements may not accurately predict the stomach contents in the setting of a stiff/fixed antrum. Scanning from antrum to fundus determined contents more accurately, especially with a prior history of abdominal radiation.

Preoperative gastric volume assessment using ultrasound in cerebral palsy pediatric patients: a prospective observational study

BackgroundAlthough cerebral palsy is a risk factor for aspiration, there is insufficient research on residual gastric volume after preoperative fasting in children with cerebral palsy. We evaluated the incidence of a full stomach by ultrasound assessment of the gastric volume in children with cerebral palsy who underwent orthopedic surgery after preoperative fasting. MethodsThe patients fasted for 8 h for solid foods and 2 h for clear liquids. We obtained the gastric antral cross-sectional area using ultrasound in the semi-recumbent and right lateral decubitus positions. A calculated stomach volume > 1.5 mL.kg−1 was considered as full, which poses a high aspiration risk. The primary outcome was the incidence of full stomach, and the secondary outcomes were the qualitative gastric volume, correlation of disease severity categorized according to the Gross Motor Function Classification System with the residual gastric volume, gastric volume per body weight, and qualitative gastric volume. ResultsThirty-seven pediatric patients with cerebral palsy, scheduled for elective orthopedic surgery, were included for analysis. Full-stomach status was observed in none, and the gastric volume per body weight was 0.5 (0.4–0.7) mL.kg−1. No significant differences were observed in the residual gastric volume (p = 0.114), gastric volume per body weight (p = 0.117), or qualitative grade of gastric volume (p = 0.642) in relation to disease severities. ConclusionChildren with cerebral palsy who fasted preoperatively had empty or nearly empty stomachs. Further studies are required to determine the optimal fasting duration for such children.

Comparison of ultrasonographic measurement of gastric antral volume and pH with or without pharmacological acid aspiration prophylaxis in low-risk surgical patients - A randomized clinical trial.

The role of preoperative pharmacological prophylaxis in preventing aspiration pneumonitis under general anesthesia (GA) in patients at low risk of aspiration pneumonitis is still under debate. We addressed the need for routine pharmacological aspiration prophylaxis in at-risk population by assessing the change in gastric volume using ultrasound with and without pharmacological acid aspiration prophylaxis. A single-center, randomized double-blinded trial, with 200 adult patients scheduled for elective surgical procedures under GA, were randomized into a prophylaxis group, in which the patients received oral famotidine and metoclopramide, and a no prophylaxis group, in which the patients did not receive any prophylaxis. Gastric volume derived from preinduction measurement of gastric antral volume by ultrasound, postinduction gastric pH, and incidences of aspiration pneumonitis were compared. Bland-Altman plot was used to determine the level of agreement between measured gastric volume and ultrasonography based on calculated gastric volume. The gastric antral cross-sectional area (CSA) and volume in the no prophylaxis group (3.12 cm2 and 20.11 ml, respectively) were comparable to the prophylaxis group (2.56 cm2 and 19.67 ml, respectively) (P-values 0.97 and 0.63, respectively). Although there was a statistically significant decrease in gastric pH in the no prophylaxis group (P-value 0.01), it was not clinically significant to increase the risk of aspiration pneumonitis based on Roberts and Shirley criteria (P-value 0.39). In an adequately fasted low-risk population, the amount of residual gastric volume was similar and below the aspiration threshold, regardless of the aspiration prophylaxis status.

Gastric-filling ultrasonography to evaluate gastric motility in patients with Parkinson's disease.

Delayed gastric emptying is a common non-motor symptom of Parkinson's disease (PD). However, there is currently no objective evaluation and diagnostic method for this condition. The purpose of this study was to evaluate the feasibility of gastric-filling ultrasonography for gastric motility in patients with PD and the relationship between gastric dynamics and gastrointestinal symptoms and motor symptoms of PD. We performed a case-control study with 38 patients with PD and 34 healthy controls. All patients underwent a 120-min ultrasonography examination using a 500-ml semi-liquid test meal. We determined the antral contraction amplitude (ACA), the antrum contraction frequency (ACF), the motility index (MI), and the gastric antral cross-sectional area (CSA). We acquired the CSA at six time points: fasting for 12 h (T0), immediately after drinking the semi-liquid test meal (T1); and at 30 (T30), 60 (T60), 90 (T90), and 120 (T120) min. We calculated the gastric emptying rate (GER) at different time points by using the CSA. We compared the GER between the groups and evaluated the correlation between the GER and gastrointestinal symptoms and motor symptoms of PD. The MI and ACF were significantly lower in the PD group compared with the control group (P < 0.05). The GER at T30 and the ACA showed no significant difference between the groups (P > 0.05). At different time points, the GER was significantly different between the PD and control groups (P < 0.001). There was no significant association between the GER and gastrointestinal symptoms; none of them were risk factors for impaired gastric emptying (odds ratio > 1). The GER was negatively correlated with the severity of PD motor symptoms (P < 0.05). Patients with PD had significantly delayed gastric emptying, which was negatively correlated with the severity of PD motor symptoms. Measuring gastric emptying by gastric-filling ultrasound had good diagnostic value in clinical screening for delayed gastric motility in patients with PD. https://www.chictr.org.cn/showproj.html?proj=126304.

Ultrasound Assessment of Gastric Volume in Parturients After High-flow Nasal Oxygen Therapy

(Anesth Analg. 2023;137:176–181) High-flow nasal oxygen (HFNO) therapy is a preferred method of respiratory support for pregnant women but concerns have been raised for gastric complications because of the positive airway pressure. Pregnancy causes physiological changes that can increase the risk of oxygen insufflation into the stomach, as well as the risk of aspiration. Aspiration risk can be determined by ultrasound assessment of gastric volume and antral cross-sectional area (CSA). This study was designed to assess the safety of HFNO therapy by examining changes in antral CSA and gastric volume via ultrasonography before and after HFNO administration, with a hypothesis that 20 minutes of HFNO therapy would increase gastric volume by 50%.

Comparative ultrasound-guided assessment of gastric volume between diabetic and non-diabetic patients posted for elective surgery—a prospective, observational, correlation study

BackgroundPerioperative aspiration of gastric contents is a serious complication and its severity depends upon the gastric volume and nature of the aspirate. Diabetic patients are more prone for aspiration because of delayed gastric emptying. USG-guided gastric examination can help in aspiration risk assessment by identifying the nature and volume of the gastric contents. This prospective observational study compared, USG-guided gastric contents and volume in fasting diabetic and non-diabetic patients posted for elective surgery under general anesthesia. Based on the history of diabetes mellitus (DM), 50 patients were divided into two groups, i.e., group A (diabetic for > 5 years, n = 25) and group B (non-diabetic, n = 25). After standard fasting period of 8 h, bedside ultrasound was conducted to assess gastric antral cross-sectional area, gastric volume and contents.ResultsThe mean gastric antral cross-sectional area (3.96 ± 2.07 versus 2.96 ± 1.88, P value 0.08), mean gastric volume (17.88 ± 19.48 versus 9.72 ± 12.29, P value 0.083) and the mean gastric volume per kg body weight (0.16 ± 0.374 versus 0.04 ± 0.20, P value 0.164) after 8 h fasting were higher in diabetics as compared to non-diabetics, but were statistically insignificant.ConclusionsDiabetic patients had comparatively slower gastric emptying and hence higher mean effecting gastric volume and gastric volume/kg body weight, after fixed hours of fasting. However, no patient had gastric volume/kg body weight > 1.5 ml/kg or presence of any solid food was visualized in any of the groups. Hence, the fixed 8 h fasting guarantees the safety from the risk of aspiration in diabetic and non-diabetic adult population.

Transabdominal gastro-intestinal ultrasonography (TGIU) for predicting feeding intolerance in critically ill patients: A prospective observational study

This study aimed at verifying the feasibility of transabdominal gastro-intestinal ultrasonography (TGIU) for predicting feeding intolerance (FI). This single-center prospective observational study comprising critically ill patients who were admitted to an intensive care unit (ICU) and received enteral nutrition through a nasogastric tube. TGIU parameters including gastric antral cross-sectional area (CSA) and acute gastrointestinal injury ultrasonography (AGIUS) score, were conducted on days 1, 3, 5, and 7 within the first week of starting enteral nutrition (EN). A total of 91 patients were eligible for inclusion and 57 showed FI. The incidence of FI was 28.6%, 41.8%, 29.7%, and 27.5% on days 1, 3, 5, and 7, respectively, and the incidence of FI was 62.6% within the first week of starting EN. Univariate logistic regression analysis showed that SOFA score, CSA, and AGIUS score, were significantly (P<0.05) associated with the FI on the same day. In the multivariate analysis including two variables, CSA, and AGIUS score were found to remain independent predictors for FI and 28-day mortality. An area under the curve (AUC) for TGIU predicted FI in the first week of starting EN (the cut-off of CSA ≥6.0cm2 yielded a sensitivity of 86.0% and specificity of 79.4%, and for AGIUS score ≥3.5 yielded a sensitivity of 87.7% and specificity of 82.4%). The predictive value of TGIU for 28-day mortality was higher than the SOFA score [0.827 (0.733-0.921) vs. 0.646 (0.519-0.774), P=0.001]. TGIU represented an effective means for predicting FI and 28-day mortality in critically ill patients. These results supported the hypothesis that persistent FI in critically ill patients is an essential determinant for poor prognosis.

Effect of facemask oxygenation with and without positive pressure ventilation on gastric volume during anesthesia induction in patients undergoing laparoscopic cholecystectomy or partial hepatectomy: a randomized controlled trial

BackgroundStudies focusing on the relationship between gastric volume and facemask oxygenation without ventilation during apnea in anesthesia induction are scarce. This study compared the change in gastric volume during apnea in anesthesia induction using facemask ventilation and facemask oxygenation without ventilation in adults undergoing laparoscopic surgery.MethodsIn this prospective, randomized, double-blinded trial, 70 adults undergoing laparoscopic surgery under general anesthesia were divided into two groups to receive facemask oxygenation with and without ventilation for 60 seconds after loss of consciousness. Before anesthesia induction and after endotracheal intubation, the gastric antral cross-sectional area was measured with ultrasound imaging. Arterial blood gases were tested at baseline (T1), after preoxygenation (T2), after loss of consciousness (T3), and before and after endotracheal intubation (T4 and T5, respectively).ResultsSixty patients were included (ventilation n = 30; non ventilation n = 30, 10 patients were excluded). The median [IQR] change of gastric antral cross-sectional area in ventilation group was significantly higher than in non ventilation group (0.83 [0.20 to 1.54] vs. 0.10 [− 0.11 to 0.56] cm2, P = 0.001). At T4 and T5, the PaO2 in ventilation group was significantly higher than in non ventilation group (T4: 391.83 ± 61.53 vs. 336.23 ± 74.99 mmHg, P < 0.01; T5: 364.00 ± 58.65 vs. 297.13 ± 86.95 mmHg, P < 0.01), while the PaCO2 in non ventilation group was significantly higher (T4: 46.57 ± 5.78 vs. 37.27 ± 6.10 mmHg, P < 0.01; T5: 48.77 ± 6.59 vs. 42.63 ± 6.03 mmHg, P < 0.01) and the pH value in non ventilation group was significantly lower (T4: 7.35 ± 0.029 vs 7.42 ± 0.047, P < 0.01; T5: 7.34 ± 0.033 vs 7.39 ± 0.044, P < 0.01). At T4, the HCO3− in non ventilation group was significantly higher (25.79 ± 2.36 vs. 23.98 ± 2.18 mmol l− 1, P < 0.01).ConclusionsDuring apnoea, the increase in gastric volume was milder in patients undergoing facemask oxygenation without ventilation than with positive pressure ventilation.Trial registrationChiCTR2100054193, 10/12/2021, Title: “Effect of positive pressure and non-positive pressure ventilation on gastric volume during induction of general anesthesia in laparoscopic surgery: a randomized controlled trial”. Website: https://www.chictr.ogr.cn.

Comparison of Gastric Emptying Time after the Ingestion of Whisky with Isocalorically Adjusted Glucose Solution.

Previous studies have shown that the liquid gastric emptying mainly depended on energy content, regardless of compositional differences. But the gastric emptying of alcoholic beverages remains unclear. Therefore, we performed the present study to compare gastric emptying times between whisky mixed with water and glucose solution with uniform energy contents and volumes. As a crossover study, 10 healthy male volunteers ingested one of 3 test solutions with a uniform volume of 150 ml, i.e., whisky with water-containing whisky 30 ml (67 kcal), sugar water containing glucose 16.8 g (67 kcal), and water (0 kcal), and the gastric emptying time of each beverage was then assessed by ultrasound measurements of the gastric antral cross-sectional area. The gastric emptying pattern of whisky with water was faster than that of isocaloric sugar water, but slower than that of water. Each antral cross-sectional area 20, 30, and 40 min after the ingestion of sugar water was significantly larger than that of whisky with water. Antral cross-sectional areas 10 and 20 min after the ingestion of water were significantly smaller than those of whisky with water. In conclusion, the gastric emptying time of whisky would be faster than that of isocaloric glucose solution and slower than that of water. Unlike the other beverages, the gastric emptying time of alcohol drinks does not purely depend on the energy content because alcohol itself has no calorie before absorption. This study is registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000034443).

7: Comparison of real-time cervical oesophageal ultrasonography and gastric antral ultrasonography to detect gastric insufflation during face-mask ventilation under general anaesthesia-Aprospective observational study.

Background and Aims:Face mask ventilation (FMV) is live saving. It is paramount to maintain oxygenation and ventilation. But FMV is avoided in rapid sequence induction( RSI), for fear of gastric insufflation. Gastric insufflation predisposes the patient to pulmonary aspiration. But the current methods available to detect gastric insufflation are not reliable markers. These include epigastric auscultation for insufflated gases, insertion of nasogastric tube to aspirate and measure the gases, and gastric antral cross-sectional area (CSA) measurement. Each of the above have their own limitations. So, reliable markers denoting gastric insufflation can prevent pulmonary aspiration and can enable “safe” FMV. Real-time transcutaneous ultrasonography(USG) of cervical oesophagus during FMV was done to look for comet-tail artefacts (acoustic shadows created by entrainment of gases into digestive tract)The aim of this study was to compare real-time upper cervical USG with gastric antral USG to detect gastric insufflation during FMV under general anaesthesia.Methods:Results:Ninety patients were recruited. One case of accidental intubation was withdrawn. Remaining 89 patients were analysed. There was an increased incidence of comet-tail artefacts in the oesophagus when compared to gastric antrum. This difference was statistically significant as analysed by Mcnemar test. The lowest peak airway pressure at which comet-tail artefacts appeared in oesophagus was 21.47 (SD-2.86) cm H20.Conclusion:Cervical oesophageal USG is better than gastric antral USG in identifying insufflation of gas into digestive tract. Limiting the airway pressures to < 20 cm H2O would be safer in providing safe FMV without cricoid pressure. Real-time USG monitoring of oesophagus in the neck for comet-tail artefacts is useful in early identification of early gastrooesophageal insufflation.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

Gastric emptying of preoperative carbohydrate in elderly assessed using gastric ultrasonography: A randomized controlled study.

Background:Preoperative carbohydrate loading enhances postoperative recovery and reduces patient discomfort. However, gastric emptying of liquids can be delayed in elderly populations. Therefore, this study aimed to evaluate the gastric emptying of 400 mL of a carbohydrate drink ingested 2 hours before surgery in elderly patients.Methods:In this prospective, randomized controlled study, patients aged >65 years were allocated to either fast from midnight (nil per os [NPO] group, n = 29) or drink 400 mL of a carbohydrate drink 2 hours before surgery (carbohydrate group, n = 29). The gastric antrum was assessed using ultrasonography in the supine position, followed by the right lateral decubitus (RLD) position. The gastric antrum was graded as grade 0 (fluid not seen in both positions), grade 1 (fluid only seen in the RLD position), and grade 2 (fluid seen in both positions). The gastric antral cross-sectional area (CSA) and aspirated residual gastric volume were measured.Results:In 58 patients, the incidence of grade 2 stomach was 13.8% in NPO group and 17.2% in carbohydrate group (P = .790). The gastric antral CSA in the supine position was larger in carbohydrate group than in NPO group (4.42 [3.72–5.18] cm2 vs 5.31 [4.35–6.92] cm2, P = .018). The gastric antral CSA in the RLD position was not different in NPO and carbohydrate groups (P = .120). There was no difference in gastric volume (2 [0–7.5] vs 3 [0–13.4], P = .331) in NPO group versus carbohydrate group.Conclusion:The incidence of grade 2 stomach was not different between NPO group and carbohydrate group in elderly patients.

Prediction of gastric fluid volume by ultrasonography in infants undergoing general anaesthesia

BackgroundPoint-of-care ultrasonography can estimate gastric contents and volume to assess the risk of pulmonary aspiration; however, its use in infants has not been well validated. We aimed to develop a predictive model for estimating gastric fluid volume using ultrasonography in infants. MethodsThis prospective observational study enrolled 200 infants (≤12 months) undergoing general anaesthesia. After anaesthetic induction, while preserving spontaneous respiration, we measured gastric antral cross-sectional area using ultrasonography in both the supine and right lateral decubitus positions. We then suctioned the gastric content and measured its volume. The primary outcome was development of a gastric fluid volume prediction model with multiple regression analysis. Agreement between the predicted volume and the suctioned volume was evaluated using a Bland–Altman plot. ResultsOverall, 192 infants were included in the final analysis. Pearson correlation analysis showed that the gastric antral cross-sectional area in the supine (P<0.001; correlation coefficient: 0.667) and right lateral decubitus (P<0.001; correlation coefficient: 0.845) positions and qualitative antral grade (P<0.001; correlation coefficient: 0.581) correlated with suctioned volume. We developed a predictive model: predicted volume (ml)=–3.7+6.5 × (right lateral decubitus cross-sectional area [cm2])–3.9 (supine cross-sectional area [cm2])+1.7 × grade (P<0.01). When comparing the predicted volume and suctioned volume, the mean bias was 0.01 ml kg−1 and the limit of agreement was –0.58 to 0.62 ml kg−1. ConclusionsGastric fluid volume can be estimated using a predictive model based on ultrasonography data in infants. Clinical trial registrationNCT03155776.

Prospective randomized double blind study for determining the efficacy of Sellick’s maneuver for preventing gastric distension during mask ventilation

Sellick’s maneuver is a technique in which pressure is applied over the cricoid cartilage to occlude the upper part of esophagus which passes behind it. It is used to prevent regurgitation of gastric and esophageal contents and gastric distension during intubation and mask ventilation. This research is conducted to determine the efficacy of Sellick's maneuver in preventing gastric distension during mask ventilation using ultrasound. Sixty patients posted for elective surgery were selected and randomly allocated to a group receiving Sellick's Maneuver (SM) or No Sellick's Maneuver (NSM). Patients of both groups had their gastric antral cross sectional area (CSA) measured using ultrasound before induction of anesthesia and after intubation and mask ventilation. The SM group was intubated after application of Sellick's maneuver. Gastric volume was then calculated from the gastric antral CSA. Changes in gastric volume among SM and NSM group were assessed to determine whether Sellick's maneuver is effective in preventing gastric distension. Changes in gastric antral CSA and gastric volume before anesthesia induction and post-intubation is lower in the SM group as compared to the NSM group. Sellick's Maneuver is effective in preventing gastric distension.

Effect of Preoperative Oral Carbohydrate Administration on Patients Undergoing Cesarean Section with Epidural Anesthesia: A Pilot Study

PurposeThe aim of this study was to evaluate the effect of preoperative oral carbohydrate administration on patients undergoing Cesarean section with epidural anesthesia. DesignRandomized controlled clinical study. MethodsA total of 75 patients undergoing Cesarean section (American Society of Anesthesiologists physical status grade I-II) were randomized to preparation with a carbohydrate drink (CHO group), flavored water (placebo group), or to the fasting group. The CHO and placebo groups were double-blinded and given 300 mL of the drink 2 hours before surgery. Visual analog scores of the patient were assessed to evaluate thirst, hunger, and anxiety level, and the gastric antral cross-sectional areas were recorded by ultrasonography during the operative period. Insulin resistance was calculated on the basis of the blood glucose and insulin levels assessed before administration and after surgery. FindingsThe CHO and placebo groups did not show an increase in gastric fluid volumes in terms of gastric antral cross-sectional area, and there were no adverse events. The visual analog scale scores at preoperative baseline were not different between groups . During the preoperative waiting period, preparation with CHO reduced not only thirst and anxiety more efficiently than water (placebo) but also hunger (P < .05), whereas water did not. No difference was observed in insulin resistance between groups before intake of the drink. Compared with the preoperative levels, insulin resistance showed a statistically significant increase in all groups (P < .05); however, the increase was significantly higher in the fasting and placebo groups than in the CHO group (P < .05). ConclusionsPreoperative administration of CHO decreases postoperative insulin resistance and enhances pregnant women's comfort, leading to a reduced sense of thirst, hunger, and anxiety during the preoperative period for Cesarean section.

Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate-rich drink in young children: A randomized crossover study.

A recent consensus statement in Europe has suggested that the fasting time for clear liquid in children can be shortened to 1hour before a surgery. However, the study to show that 1-hour fasting time for clear fluids is safe in young children is still lacking. This study aimed to investigate the gastric emptying time for carbohydrate-rich drink and regular 5% glucose solution in children aged 3-7years. After overnight fasting, individuals were randomly assigned to ingest 5mLkg-1 of either carbohydrate-rich drink or 5% glucose solution. One week later, the same subjects were asked to ingest the other one. Ultrasonography was performed to examine the gastric contents. Gastric antral cross-sectional area was measured, and the gastric fluid volume was calculated before and after fluid ingestion within 120minutes. The primary outcome was the gastric emptying time for both the clear fluids calculated using the antral cross-sectional area and logarithms of gastric fluid volume. The degrees of thirst and hunger of two drinks were evaluated using a visual analogue scale as the secondary outcomes. Data from 16 individuals were analyzed. In the glucose solution group, the antral cross-sectional area and logarithms of gastric fluid volume returned to baseline at 30minutes after ingestion. However, in the carbohydrate-rich drink group, the median [interquartile range; range] antral cross-sectional area (3.69 [2.64-5.15; 1.83-8.93] cm2 vs 2.41 [2.10-2.96; 1.81-4.37] cm2 , P<.001) and mean (95% confidence interval) logarithms of gastric fluid volume (2.54 [2.30-2.79] mL vs 2.12 [1.94-2.30] mL, P=.048) were still higher than at 60minutes and returned to the baseline values at 90minutes after ingestion, respectively. The degree of thirst was lower in the glucose solution group than that in the carbohydrate-rich drink group. Gastric emptying of carbohydrate-rich drink is slower than that of 5% glucose solution but the residual gastric fluid volume is low one hour after ingestion of 5mLkg-1 of either fluid.

Comparison of fasting gastric volume using ultrasound in diabetic and non-diabetic patients in elective surgery: An observational study.

Background and Aims:Gastroparesis despite standard fasting in diabetic patients may increase the aspiration risk. This study aimed to compare fasting gastric volume (GV) of diabetic with non-diabetic patients scheduled for elective surgery using USG.Methods:This prospective observational study included 53 diabetic and 50 non-diabetic patients aged >18 years, American Society of Anesthesiologists' physical status I-III having similar fasting intervals. Before induction, using standard gastric scanning protocol, qualitative and quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed with a curved array probe. USG grade, cross-sectional area (CSA) of the antrum and GV were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively.Results:In supine position, CC and AP diameters were 1.96 ± 0.41 cm and 0.9 ± 0.57 cm in control group and 2.28 ± 0.50 cm and 1.39 ± 0.44 cm in diabetic group, respectively. In RLD, CC was 2.28 ± 0.57 cm and AP was 1.24 ± 0.42 cm in control group as compared to CC 2.54 ± 0.56 cm and AP 1.82 ± 0.56 cm in diabetic group. The CSA of 2.57 ± 1.19 cm2 and 3.73 ± 1.61 cm2 in diabetic were significantly higher (P = 0.001) than 1.41 ± 0.55 cm2 and 2.30 ± 1.18 cm2 of control, in supine and RLD positions, respectively. GV was 4.20 ± 22.26 ml in control group and 9.15 ± 25.70 ml in diabetic group.Conclusion:Diabetic patients have higher gastric antral cross-sectional area and gastric volumes as observed by gastric ultrasound than the non-diabetic patients.

Evaluation of Gastric Emptying by Ultrasonography after Recommended Fasting Period and Administration of Prokinetic in End-stage Renal Disease Patients.

Background:Delayed gastric emptying is observed in end-stage renal disease (ESRD).Aims:Evaluation of gastric emptying after recommended fasting period and on oral administration of prokinetic in ESRD patients using ultrasonography (USG).Settings and Design:Randomized, double-blind, prospective, controlled study.Materials and Methods:After institutional ethics committee approval, 200 patients were divided randomly into two equal groups. Three sessions of USG evaluation of gastric antrum were done in supine and right lateral position for assessing gastric emptying, first at 8 am, second after the light meal at 8.30 am, and third after 6 h of light meal. Group A received placebo (sugar-coated pill) and Group B received tablet metoclopramide hydrochloride 10 mg after second session of USG. In each session, measurement of anteroposterior and craniocaudal diameters of gastric antrum was done, and then cross-sectional area was estimated. Three-point grading system (Perlas) was used to perform qualitative evaluation.Statistical Analysis:Comparison of normally distributed continuous variables was performed using Student's t-test. Nominal categorical data were compared using Chi-squared test. Nonnormal distribution continuous variables were compared using Mann–Whitney U-test.Results:6 h of fasting after light meal showed that Group A only had 14% incidence of complete gastric emptying, whereas Group B had 71% as compared by Perlas grading. Gastric antral cross-sectional area measured both in supine (480.89 ± 84.92) and right lateral (575.40 ± 92.62) position of Group A was more than Group B supine (394.15 ± 62.80) and right lateral (470.25 ± 73.63) position (P < 0.05).Conclusion:USG of ESRD patients preoperatively can evaluate gastric contents to assess risk of pulmonary aspiration and guide anesthetic management. Metoclopramide is a good drug to enhance gastric emptying in ESRD patients within the recommended fasting period.

Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section

Background and objectivesPregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. MethodIn this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. ResultsThe median (IIQ) for gastric antral cross-sectional area was 4cm2 (2.8–6.3), for the estimated gastric volume it was 49.8mL (33.7–87.2), and for the gastric volume estimated in mL.kg−1 it was 0.62mL.kg−1 (0.39–0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3cm2 (95% CI: 7.6–15.6) and 1.42mL.kg−1 (95% CI: 1.20–2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2–9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p<0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p<0.01 and p<0.02. ConclusionMeasuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.