Risk Of Pulmonary Aspiration Research Articles

Glucagon-like peptide-1 receptor agonists before upper gastrointestinal endoscopy and risk of pulmonary aspiration or discontinuation of procedure: cohort study

ObjectiveTo assess whether use of glucagon-like peptide-1 (GLP-1) receptor agonists before upper gastrointestinal endoscopy is associated with increased risk of pulmonary aspiration or discontinuation of the procedure compared with sodium-glucose...

A Comparison of Tracheal Intubation Using Direct Laryngoscope and Video Laryngoscope in the Sellick and Trendelenburg Position with That Using Direct Laryngoscope in the Supine Sniffing Position: A Randomized Controlled Trial.

Background: Tracheal intubation in the Sellick and Trendelenburg position (ST position) can prevent pulmonary aspiration but increase the difficulty of tracheal intubation. We compared tracheal intubation using video and direct laryngoscopy in the ST position with direct laryngoscopy in the supine sniffing position to evaluate the overall intubation performance. Methods: One hundred and twenty patients were randomly assigned to three groups: direct laryngoscope in the supine sniffing position (control), direct laryngoscope in the ST position (ST direct), and video laryngoscope in the ST position (ST video). The primary outcome was the intubation time; secondary outcomes included the first attempt success rate of tracheal intubation, intubation difficulty scale score, operator's subjective assessment of intubation difficulty, and modified Cormack-Lehane grades. Results: The median intubation times were greater in the ST direct (36.0 s) and video (34.5 s) than the control (28.0 s) groups. The first attempt success rate decreased in the ST direct (77.5%) but not the video (95.0%) group compared with the control group (100%). Conclusions: The challenges of tracheal intubation in the ST position, aimed at reducing the risk of pulmonary aspiration, can be mitigated by using a video laryngoscope, despite slightly longer intubation times.

Development of an Online Training System on Pulmonary Aspiration for Clinical Nurses.

Pulmonary aspiration is a particularly problematic condition in patients in hospitals and nursing home. To promote patient safety and prevent serious complications, the nurse's role in preventing and caring for patient at high risk of pulmonary aspiration is crucial. Our team has developed an online training system on pulmonary aspiration for nurses to improve their ability to identify early risk factors, scientifically assess the risk of aspiration, and effectively intervene and manage when pulmonary aspiration occurs. This system was developed via WeChat app, the most popular social media application in China. It has four main functions, such as online training, online assessment, announcement interaction, and learning record. This online training systems offer the benefits of flexible learning time with anytime access, rich resources that are easy to update, and greater cost-effectiveness. This paper presents and discusses the development process of this system.

Development of an Intelligent Risk Hierarchical Management System on Pulmonary Aspiration for the Elderly.

For the elderly, the risks associated with pulmonary aspiration are significant, and can severely impact their quality of life. Therefore, the management of pulmonary aspiration risk is crucial in promoting healthy aging, an aspect often overlooked in self-health management for the elderly. To enhance self-management of pulmonary aspiration risk among the elderly, we have organized a multidisciplinary team to develop an intelligent risk hierarchical management system on pulmonary aspiration for the elderly. This system tailors the assessment with different questionnaires based on the elderly individual's environment. Additionally, it utilizes elderly-friendly formats such as pictures, videos and animations, making it easier for seniors to comprehend the occurrence and hazards of pulmonary aspiration. This enables them to proactively take preventive measures to manage the risk, thus achieving self-management of pulmonary aspiration risk.

Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study.

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are effective in diabetes and obesity, reducing hyperglycemia by increasing insulin release and delaying gastric emptying. However, they can cause gastroparesis, raising concerns about aspiration during procedures. Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration. To evaluate the effect of GLP-1 RAs on gastric residual contents during endoscopic procedures. A retrospective chart review at BronxCare Health System, New York, from January 2019 to October 2023, assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures. Two groups were compared based on dietary status before the procedure. Data included demographics, symptoms of gastroparesis, opiate use, hemoglobin A1c, GLP-1 agonist indication, endoscopic details, and aspiration occurrence. IBM SPSS was used for analysis, calculating means, standard deviations, and applying Pearson's chi-square and t-tests for associations, with P < 0.05 as being significant. During the study, 306 patients were included, with 41.2% on a clear liquid/low residue diet and 58.8% on a regular diet before endoscopy. Most patients (63.1%) were male, with a mean age of 60 ± 12 years. The majority (85.6%) were on GLP-1 RAs for diabetes, and 10.1% reported digestive symptoms before endoscopy. Among those on a clear liquid diet, 1.5% had residual food at endoscopy compared to 10% on a regular diet, which was statistically significant (P = 0.03). Out of 31 patients with digestive symptoms, 13% had residual food, all from the regular diet group (P = 0.130). No complications were reported during or after the procedures. The study reflects a significant rise in GLP-1 RA use for diabetes and obesity. A 24-hour liquid diet seems safe for endoscopic procedures without aspiration. Patients with upper gastrointestinal symptoms might have a higher residual food risk, though not statistically significant. Further research is needed to assess risks based on diabetes duration, gastroparesis, and GLP-1 RA dosing, aiming to minimize interruptions in therapy during procedures.

Prevalence of Aspiration Risk due to a Full Stomach Assessed by Gastric Ultrasonography in Diabetic Patients Undergoing Non-Emergency Surgery

Background: Pulmonary aspiration causes severe complications and high mortality, especially in diabetic patients during the perioperative period. Gastric ultrasonography is able to detect a patient with full stomach that poses high risk of pulmonary aspiration. However, in Thailand, there is no previous prevalence study. Objective: To study the prevalence of aspiration risk resulting from full stomach in diabetic patients during non-emergency surgery and to identify related risk factors using gastric ultrasonography. Materials and Methods: One hundred nineteen diabetic patients were enrolled between July 2021 and January 2022. A preoperative ultrasound examination of gastric content was performed in the right lateral decubitus position. Aspiration risk due to full stomach was defined as having solid contents or fluid volume more than 1.5 mL/kg. The associated risk factors were analyzed using multiple logistic regression models. Results: The prevalence of aspiration risk due to “full stomach” was 18.49% (22 out of 119 patients). Age between 65 and 84 years old (adjusted OR 015, 95% CI 0.04 to 0.54) and blood urea nitrogen (BUN) levels (adjusted OR 1.04, 95% CI 1.00 to 1.08) were statistically significantly associated risk factors (p&lt;0.05). There was no incidence of pulmonary aspiration during the study period. Conclusion: While diabetic patients were advised to follow standard fasting guidelines, the risk of pulmonary aspiration persisted. Implementing an anesthetic plan as though the patient belonged to the “full stomach” group helped ensure the patient’s safety. Additionally, preoperative gastric ultrasound assessment is able to detect “full stomach” condition, thereby, further reducing the incidence of pulmonary aspiration.

Assessing Residual Gastric Fluid Volume after Administering Diluted Oral Contrast until One Hour Prior to Anesthesia in Children: An Observational Cohort Study.

Background: Gastric fluid volume has been used as a surrogate marker for pulmonary aspiration risk in studies evaluating fasting protocol safety. This study measured residual gastric fluid volume in children using a protocol in which diluted oral contrast medium was administered up until one hour before anesthesia. Methods: This was a single-center prospective observational cohort trial of 70 children for elective abdominal/pelvic computed tomography (CT). Imaging was performed after diluted enteral contrast medium administration, beginning two hours before and ending at least one hour before induction. For each patient, gastric fluid volume was calculated using an image region of interest. The primary outcome measure was gastric fluid volume measured using the computed tomography image. Results: The median time from the end of contrast administration to imaging was 1.5 h (range: 1.1 to 2.2 h). Residual gastric volume, measured using CT was <0.4 mL/Kg in 33%; ≥0.4 mL/Kg in 67%; and ≥1.5 mL/Kg in 44% of patients. Residual gastric volumes measured using CT and aspiration were moderately correlated (Spearman's correlation coefficient = 0.41, p = 0.0003). However, the median residual gastric volume measured using CT (1.17, IQR: 0.22 to 2.38 mL/Kg) was higher than that of aspiration (0.51, IQR: 0 to 1.58 mL/Kg, p = 0.0008 on differences in paired measures). Three cases of vomiting were reported. No evidence of pulmonary aspiration was identified. Conclusions: Children who receive large quantities of clear fluid up to one hour before anesthesia can have a significant gastric residual volume.

Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study.

Background/Objectives: Preoperative fasting guidelines traditionally aim to reduce pulmonary aspiration risk. However, concerns over the adverse effects of prolonged fasting have led to exploring alternatives. This study aimed to investigate the impact of preoperative clear liquid intake on postoperative outcomes in children undergoing minimally invasive repair of pectus excavatum (MIRPE). Methods: A prospective randomized controlled study was conducted on children aged 3-6 years scheduled for elective MIRPE. Patients were randomized into either a routine overnight fasting group (NPO) or a clear liquid group. The incidence and severity of emergence delirium (ED) were assessed using Pediatric Anesthesia Emergence Delirium (PAED) and Watcha scales at recovery room. Postoperative pain scores and opioid requirements were evaluated at intervals of 1-6 h, 6-12 h, and 12-24 h after surgery. Results: Fasting time was 178.6 ± 149.5 min and 608.9 ± 148.4 min in the clear liquid group compared and NPO group, respectively. The incidence of ED, measured by PAED and Watcha scales, was lower in the clear liquid group (PAED score ≥ 12: 55.6% vs. 85.2%, p = 0.037; Watcha score ≥ 3: 51.9% vs. 85.2%, p = 0.019). The highest PAED score recorded in the recovery room was significantly lower in the clear liquid group (11.4 ± 2.8 vs. 14.6 ± 2.8, p < 0.001). Clear liquid group showed significantly lower pain scores at 1-6, 6-12, and 12-24 h postoperatively. Additionally, clear liquid group had lower opioid requirement at 1-6 and 6-12 h postoperatively. Conclusions: Preoperative clear liquid consumption was associated with a lower incidence of ED in pediatric patients undergoing MIRPE.

Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice.

Glucagon-like peptide-1 receptor agonists are used increasingly in the management of patients living with type 2 diabetes mellitus and obesity. In patients using glucagon-like peptide-1 receptor agonists, a key concern in the peri-operative period is the increased risk of pulmonary aspiration due to delayed gastric emptying. This review provides an overview of the pharmacodynamic and pharmacokinetic properties of glucagon-like peptide-1 receptor agonists and the risk of delayed gastric emptying and aspiration. We conducted searches of MEDLINE and EMBASE databases of articles published before January 2024 using the keywords and medical subject headings: incretins; glucagon-like peptide-1; GLP-1; glucagon-like peptide-1 receptor agonists; GLP-1 RA; peri-operative period; perioperative; peri-operative; stomach emptying; gastric emptying; pulmonary aspiration; aspiration; food regurgitation; and regurgitation. The evidence was analysed, synthesised and reported narratively. A total of 1213 articles were located after duplicates were removed. Two authors screened the titles and abstracts to identify those studies which assessed specifically the risk of delayed gastric emptying and pulmonary aspiration or regurgitation in the peri-operative period. We searched manually the reference lists of relevant studies to identify any additional case reports. Ten studies were identified. Available evidence was limited to case reports, case series and observational work. There is insufficient evidence to put forward definitive guidance regarding the ideal cessation period for glucagon-like peptide-1 receptor agonists before elective surgery. Precautionary practice is required until more evidence becomes available. We suggest an individualised, evidence-based approach. In patients living with type 2 diabetes mellitus, there is concern that prolonged cessation before surgery will have a detrimental effect on peri-operative glycaemic control and discussion with an endocrinologist is advised. For patients taking glucagon-like peptide-1 receptor agonists for weight management, these drugs should be withheld for at least three half-lives before an elective surgical procedure.

Airway management and pulmonary aspiration during surgical interventions in pregnant women in the 2nd/3rd trimester and immediate postpartum – a retrospective study in a tertiary care university hospital

BackgroundPregnancy is associated with an increased risk of pulmonary aspiration during general anaesthesia, but the incidence of this complication is not well defined.MethodsWe performed a retrospective database review in a tertiary care university hospital to determine the incidence of pulmonary aspiration in pregnant patients undergoing endotracheal intubation, with and without Rapid Sequence Induction (RSI), as well as face-mask ventilation and supraglottic airway devices. We included Patients in the 2nd or 3rd trimester of pregnancy and immediate postpartum undergoing surgical procedures. The primary endpoint was the occurrence of pulmonary aspiration.ResultsData from 2,390 patients undergoing general anaesthesia for cerclage of cervix uteri, manual removal of retained placenta, repair of obstetric laceration, or postpartum bleeding were retrospectively evaluated. A supraglottic airway device or face-mask ventilation was used in 1,425/2,390 (60%) of patients, while 638/2,390 (27%) were intubated. RSI was used in 522/638 (82%) of patients undergoing tracheal intubation, or 522/2,390 (22%) of the entire cohort. In-depth review of the charts, including 54 patients who had been initially classified as “possible pulmonary aspiration" by anaesthetists, revealed that this adverse event did not occur in the cohort.ConclusionsIn conclusion, in this obstetric surgery patient population at risk for pulmonary aspiration, supraglottic airway devices were used in approximately 60% of cases. Yet, no aspiration event was detected with either a supraglottic airway or endotracheal intubation.

Ultrasound Assessment of Prevalence of ‘At Risk Stomach’ in Children Undergoing Elective Surgery- Prospective, Observational Study

Children may be at increased risk of pulmonary aspiration because of retention of gastric contents caused by pain or inadequate fasting. We performed this study to analyze the use of ultrasound for evaluation of gastric ultrasound in children less than 12 years. Two hundred children, 1-12 years of age belonging to ASA physical status I to II, scheduled to undergo elective surgery were included in the study. Patients were scanned in supine position followed by right lateral decubitus position (RLD). In qualitative assessment, the antrum was judged to contain fluid if it appeared to have an endocavitary lumen with hypoechoic content and distended walls. All measurements were taken with antrum at rest (between contraction) to avoid underestimating volume. It was observed that majority of the children were in Perlas grade 0, 116(58%) followed by 75 children in grade 1 and 9 children in grade 2. Using Karl Pearson’s Correlation coefficient, low positive correlation was found between gastric volume and fasting status solid (in hours) and the variation (correlation) was found to be statistically non-significant (r=0.139; p&gt;0.05). There is no proportionate decline in gastric volume with increased duration of preoperative fasting. Ultrasonographic measurement of antral area can be of interest to anesthesiologist for accurate qualitative and quantitative estimation of preoperative gastric contents and volume. However, gastric ultrasonography has to be validated in further trials involving a larger patient population before it can become a routine standard of care in perioperative period.

Should We Stop Glucagon-Like Peptide-1 Receptor Agonists Before Surgical or Endoscopic Procedures? Balancing Limited Evidence With Clinical Judgment.

The American Society of Anesthesiologists (ASA) Task Force recently recommended discontinuing glucagon-like peptide-1 receptor agonist (GLP-1 RA) agents before surgery because of the potential risk of pulmonary aspiration. However, there is limited scientific evidence to support this recommendation, and holding GLP-1 RA treatment may worsen glycemic control in patients with diabetes. As we await further safety data to manage GLP-1 RA in the perioperative period, we suggest an alternative multidisciplinary approach to manage patients undergoing elective surgery. Well-conducted observational and prospective studies are needed to determine the risk of pulmonary aspiration in persons receiving GLP-1 RA for the treatment of diabetes and obesity, as well as the short-term impact of discontinuing GLP-1 RA on glycemic control before elective procedures in persons with diabetes.

Diabetic Patients, Assessment of Preoperative Gastric Contents, and Potential Reduction of Risk of Pulmonary Aspiration.

Diabetic Patients, Assessment of Preoperative Gastric Contents, and Potential Reduction of Risk of Pulmonary Aspiration.

Asuhan Keperawatan Kritis Pada Pasien Chronic Kidney Disease CKD Dengan Intervensi Inovasi Memberikan Nutrisi Enteral Menggunakan Metode Intermiten Feeding Untuk Mengurangi Produksi Residu Lambung di Ruang ICU RSU Kabupaten Tengerang

Background: Critical care developed starting from a need for patients experiencing life-threatening illnesses that could be better met if the patient was cared for in a different room. Chronic Kidney Disease (CKD) is defined as a decrease in kidney function characterized by a glomerular filtration rate (GFR) &lt; 60 ml/min/1.73 m2 that occurs for more than 3 months (Mahesvara, 2020). Nutrition is an important part of the management of critical patients such as those suffering from advanced Chronic Kidney Disease (CKD). Providing nutrition to critical patients is to encourage the healing process. Inaccuracy in administering enteral nutrition can cause complications such as high gastric residual volume, gastric retention, diarrhea, nausea and vomiting. High gastric residues during enteral nutrition increase the risk of pulmonary aspiration which is the most severe complication of enteral nutrition. Intermittent feeding is one method of providing enteral nutrition to prevent these complications. The aim of this research is to provide comprehensive nursing care for patients with Chronic Kidney Disease (CKD). This writing method uses patient intervention and observation carried out for three days, to determine the patient's condition and provide appropriate nursing care which is then documented. Results: Based on the results of the intervention and monitoring carried out, it can be concluded that there are differences in the conditions of gastric residue production before and after the enteral feeding intervention using the intermittent feeding method. With the result criteria of maintaining nutritious food intake increases. Conclusion: In critical patients there is a slowdown in gastric emptying and intestinal motility so that if enteral nutrition is given quickly into the stomach there will be an increase in gastric residue. Nursing action as an evidence base that can be given is in the form of providing enteral nutrition using the intermittent feeding method so that the stomach can be better prepared to receive nutrition because it is given gradually, a stomach that is not completely filled will be able to digest food better and the stomach will empty more quickly, thereby reducing the risk of aspiration.

Airway Management for Emergency Spinal Epidural Hematoma Evacuation With Awake Spine Surgery: Case Report and Literature Review.

Postoperative spinal epidural hematomas (pSEHs) are a rare complication of microdiscectomy surgery. The hematoma may be unnoticed intraoperatively, but timely treatment may prevent permanent neurologic impairment. Airway management in patients with a full stomach is generally performed with rapid sequence intubation and general anesthesia. Awake spine surgery without intravenous analgesia or sedation may be beneficial in patients with a full stomach who are at higher risk for pulmonary aspiration with general anesthesia due to a loss of non-per-oral (NPO) status. The authors propose that it can also be performed in cases of urgent/emergent postsurgical epidural hematoma evacuation. We present the airway management of a 41-year-old man who underwent a minimally invasive microdiscectomy with normal strength immediately after surgery but developed progressive weakness with right foot dorsiflexion, right extensor hallucis longus muscle weakness, and progressive right lower extremity ascending numbness over the course of the first 2 hours after surgery due to an epidural hematoma. The patient underwent urgent awake epidural hematoma evacuation with a spinal anesthetic. Afterward, the patient recovered neurological function and was discharged the following morning. pSEHs are a rare complication of microdiscectomy surgery. The purpose of this article is to describe the novel use of awake spine surgery in emergent epidural hematoma evacuation and demonstrate its feasibility. In emergencies, when a patient is not NPO, awake spine surgery can safely be performed with no sedation, ensuring the patient can protect their airway and avoid the risk of aspiration.

Effect of Unexpected Prolonged Fasting on Patients Undergoing Elective Surgery under Spinal Anaesthesia: An Observational Study

Introduction: Preoperative fasting is a standard practice aimed at minimising the risk of pulmonary aspiration during surgery. However, patients often experience prolonged fasting periods beyond the recommended duration due to unanticipated delays in the operating theatre, communication failures between teams, inadequate preoperative planning and other factors. Aim: To investigate the effects of unexpectedly prolonged fasting on intraoperative and postoperative parameters in patients undergoing elective surgery under spinal anaesthesia. Materials and Methods: This prospective observational study was conducted from October 2023 to June 2024 at the Department of Anaesthesiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. The study included 70 patients undergoing elective surgery under spinal anaesthesia. Patients were divided into two groups: Group A (AM group, n=35), scheduled for surgery between 8:00 AM and 12:00 PM and Group B (PM group, n=35), scheduled for surgery after 12:00 PM or with delayed surgeries. Intraoperative parameters, including Mean Arterial Pressure (MAP), Heart Rate (HR), oxygen saturation (SpO2 ) and random blood glucose levels, were recorded at specific time points. Postoperative outcomes, such as nausea, vomiting and random blood glucose levels, were also assessed. Continuous and discrete variables were summarised as mean±SD and median, while categorical variables were presented as frequencies and percentages. Associations between categorical variables were tested using Pearson’s Chi-square or Fisher’s-exact test, with p-values&lt;0.05 considered statistically significant. Results: The PM group exhibited higher preoperative random blood glucose levels (102.3±18.7 mg/dL) compared to the AM group (89.2±12.5 mg/dL). Postoperative nausea and vomiting were observed in 5 (14.3%) patients in the AM group and 11 (31.4%) patients in the PM group. Both groups showed a gradual decrease in MAP and HR from the preoperative period to 30 minutes after spinal anaesthesia administration, with slightly higher values noted in the PM group. No significant differences in SpO2 were observed between the groups. Conclusion: Unexpected prolonged fasting before elective surgery under spinal anaesthesia may contribute to higher preoperative blood glucose levels and an increased risk of postoperative nausea and vomiting. These findings underscore the importance of adhering to preoperative fasting guidelines and exploring potential strategies to minimise prolonged fasting periods, such as carbohydrate loading or allowing clear fluids closer to surgery

Gastric ultrasound for perioperative prandial status

Gastric ultrasound is a valuable tool for real-time assessment of gastric content at the bedside, reducing the risk of pulmonary aspiration. A good understanding of the gastric sonoanatomy and techniques for image acquisition will allow the clinician to utilize ultrasound to assess gastric content and volume via qualitative and quantitativeassessment to risk stratify their patient prior to the surgery. We describe the core principles of gastric ultrasound and its practical implications on patient safety during the perioperative period.

Incidence of adverse respiratory events after adjustment of clear fluid fasting recommendations to 1 h: a prospective, observational, multi-institutional cohort study

BackgroundPreoperative fasting reduces the risk of pulmonary aspiration during anaesthesia, and 2-h fasting for clear fluids has commonly been recommended. Based on recent evidence of shorter fasting times being safe, the Swiss Society of Paediatric Anaesthesia began recommending 1-h fasting for clear fluids in 2018. This prospective, observational, multi-institutional cohort study aimed to investigate the incidence of adverse respiratory events after implementing the new national recommendation. MethodsEleven Swiss anaesthesia institutions joined this cohort study and included patients aged 0–15 yr undergoing anaesthesia for elective procedures after implementation of the 1-h fasting instruction. The primary outcome was the perioperative (defined as the time from anaesthesia induction to emergence) incidence of pulmonary aspiration, gastric regurgitation, and vomiting. Data are presented as median (inter-quartile range; minimum–maximum) or count (percentage). ResultsFrom June 2019 to July 2021, 22 766 anaesthetics were recorded with pulmonary aspiration occurring in 25 (0.11%), gastric regurgitation in 34 (0.15%), and vomiting in 85 (0.37%) cases. No major morbidity or mortality was associated with pulmonary aspiration. Subgroup analysis by effective fasting times (<2 h [n=7306] vs ≥2 h [n=14 660]) showed no significant difference for pulmonary aspiration between these two groups (9 [0.12%] vs 16 [0.11%], P=0.678). Median effective fasting time for clear fluids was 157 [104–314; 2–2385] min. ConclusionsImplementing a national recommendation of 1-h clear fluid fasting was not associated with a higher incidence of pulmonary aspiration compared with previously reported data.

Evaluation of ultrasound-measured gastric volume and content in type 2 diabetes mellitus patients undergoing elective surgery: a prospective observational study

Objectives: Delayed gastric emptying create a risk of pulmonary aspiration during anesthesia. We aim to assess the antral cross-sectional area (CSA) and gastric volume using ultrasound techniques and to investigate the relationship between these variables and both the duration and regulation of type 2 diabetes mellitus (DM). Methods: Gastric volume was estimated by measuring the antral CSA in the supine and right lateral decubitus (RLD) positions in 80 patients. The antral content was qualitatively classified according to Perlas et al. (grades 0, 1, and 2), and gastric volume was computed using a previously described formula. The presence of solid content or &amp;gt; 1.5 mL/kg fluid in the stomach was classified as indicative of a full stomach. Results: The mean duration of diabetes among the subjects was 9.4 ± 3.7 years. The mean fasting duration was 10.2 ± 2.1 hours for solids and 2.5 ± 0.7 for liquids. Twelve of the 80 patients exhibited grade 2 stomach. Age (p = 0.005), Body mass index (p = 0.001), solid fasting duration (p = 0.027), and supine and RLD CSA (p &amp;lt; 0.001 for both) were significantly associated with full stomach. A history of ≥8 years of diabetes (p &amp;lt; 0.001) and peripheral neuropathy (p = 0.005) was identified as a risk factor for a full stomach. Conclusions: Despite adherence to standard fasting protocols, 15% of the type 2 DM patients were identified with a 'full stomach' condition. Preoperative ultrasound assessment of gastric contents in patients with type 2 DM, especially with long-standing diabetes (≥ 8 years) and with peripheral neuropathy is recommended. The findings of this study necessitate additional investigation to support the conceptualization of specific guidelines for diabetes to mitigate the risk of pulmonary aspiration.

A Multicenter Interdisciplinary Survey of Practices and Opinions Regarding Oral Intake During Labor

(Int J Obstet Anesth. 2022;52:103598) Restrictive food policies during labor were originally established to decrease the risk of pulmonary aspiration. Over time, the need for restricting food has been questioned and guidelines currently vary between centers. This multicenter national survey was conducted to determine current practices and opinions by obstetric providers concerning maternal oral intake in labor and delivery units.