Gastric ultrasonography in assessment and quantification of gastric contents in fasting diabetic and nondiabetic patients

Abstract

Context: Gastric ultrasound is an emerging point-of-care diagnostic tool to examine stomach contents and determine pulmonary aspiration risk at the bedside. This is helpful in guiding airway and/or anesthetic management in the acute care setting, when nil per oral (NPO) status is doubtful or unknown or patient has conditions or comorbidities that affect gastric emptying. Aims: The objectives of the study were to evaluate and quantify the gastric contents and grade the fullness of the stomach in fasting patients. Settings and Design: This was an observational, analytical study conducted on patients who presented for elective surgeries who were fasted for 8 hours for solids and 6 hours for clear liquids. Materials and Methods: Adult patients aged between 18 and 70 years of American Society of Anesthesiology physical status 1–3 were included in the study. Gastric ultrasonography was performed and gastric volume was calculated. Data were entered in Microsoft Excel 2007 and analyzed using SPSS version 22.0. Results: Our study included a total of eighty subjects. The mean age in the diabetic group was 49.3 ± 16.4 years and in the nondiabetic group 49.4 ± 16.8 years. Despite fasting status, 75% of the subjects were found to have Grade 1 (up to 100 ml) gastric contents on ultrasonography. The data were found to be statistically significant with P < 0.05. There was no significant correlation of age and ultrasonography findings. However, body mass index of the patient was found to have a strong correlation with gastric content and its volume (P < 0.0001). Conclusion: In the current practice, NPO status, especially for emergency cases, is elicited via history which is unreliable, and in individuals at higher risk for delayed gastric emptying, this may pose a greater threat for aspiration. Using gastric ultrasonography as a screening tool prior to planning the anesthetic induction and technique can help avoid unnecessary perioperative complications.

Keywords

• acid aspiration syndrome
• aspiration pneumonia
• diabetes mellitus
• gastric acid aspiration syndrome
• ultrasonography