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 wi...

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Main Authors: Li Zhou, Yi Yang, Lei Yang, Wei Cao, Heng Jing, Yan Xu, Xiaojuan Jiang, Danfeng Xu, Qianhui Xiao, Chunling Jiang, Lulong Bo
Format: Article
Language:English
Published: BMC 2019-10-01
Series:BMC Anesthesiology
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12871-019-0848-x
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spelling doaj-4818dec172a848609cb64af7ba8a19ed2020-11-25T03:42:18ZengBMCBMC Anesthesiology1471-22532019-10-011911910.1186/s12871-019-0848-xPoint-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort studyLi Zhou0Yi Yang1Lei Yang2Wei Cao3Heng Jing4Yan Xu5Xiaojuan Jiang6Danfeng Xu7Qianhui Xiao8Chunling Jiang9Lulong Bo10Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan UniversityDepartment of Anesthesiology, Cheng Du Shang Jin Nan Fu HospitalDepartment of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan UniversityDepartment of Anesthesiology, Cheng Du Shang Jin Nan Fu HospitalDepartment of Anesthesiology, Cheng Du Shang Jin Nan Fu HospitalDepartment of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan UniversityDepartment of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan UniversityDepartment of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan UniversityDepartment of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan UniversityDepartment of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan UniversityFaculty of Anaesthesiology, Changhai Hospital, Naval Medical UniversityAbstract 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.http://link.springer.com/article/10.1186/s12871-019-0848-xType 2 diabetes mellitusGastric emptyingRegurgitation and aspirationUltrasonography
collection DOAJ
language English
format Article
sources DOAJ
author Li Zhou
Yi Yang
Lei Yang
Wei Cao
Heng Jing
Yan Xu
Xiaojuan Jiang
Danfeng Xu
Qianhui Xiao
Chunling Jiang
Lulong Bo
spellingShingle Li Zhou
Yi Yang
Lei Yang
Wei Cao
Heng Jing
Yan Xu
Xiaojuan Jiang
Danfeng Xu
Qianhui Xiao
Chunling Jiang
Lulong Bo
Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study
BMC Anesthesiology
Type 2 diabetes mellitus
Gastric emptying
Regurgitation and aspiration
Ultrasonography
author_facet Li Zhou
Yi Yang
Lei Yang
Wei Cao
Heng Jing
Yan Xu
Xiaojuan Jiang
Danfeng Xu
Qianhui Xiao
Chunling Jiang
Lulong Bo
author_sort Li Zhou
title Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study
title_short Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study
title_full Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study
title_fullStr Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study
title_full_unstemmed Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study
title_sort point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study
publisher BMC
series BMC Anesthesiology
issn 1471-2253
publishDate 2019-10-01
description 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.
topic Type 2 diabetes mellitus
Gastric emptying
Regurgitation and aspiration
Ultrasonography
url http://link.springer.com/article/10.1186/s12871-019-0848-x
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