Gastric Volume in Diabetic Patients after Overnight Fasting vs Clear Liquid Ingestion Two Hours before Surgery Using UltraonographyA Randomised Clinical Trial

Abstract

Introduction: Perioperative gastric aspiration poses risks such as aspiration pneumonia, prolonged hospital stays, and increased mortality. Fasting guidelines may not adequately address the needs of diabetic patients due to the delayed gastric emptying often observed in this population. Aim: To assess residual gastric volume in diabetic patients who fasted overnight versus those who ingested water preoperatively using ultrasound. Materials and Methods: A randomised clinical trial enrolled 50 diabetic patients undergoing elective surgery. Patients were randomised into two groups: fasting overnight or receiving water preoperatively. Gastric ultrasound was used to measure antral dimensions and calculate gastric volume. The parameters studied included residual gastric volume in diabetic patients in the Right Lateral Decubitus (RLD) position, antral Cross-Sectional Area (CSA) in the semi-sitting position among diabetic patients, and antral CSA in the RLD position among diabetic patients. Statistical analysis involved descriptive statistics for continuous variables and Chi-square tests for categorical variables, with significance set at p-value<0.05. Results: The study enrolled 50 diabetic patients, with 25 in group A and 25 in group B. The mean age of patients in group A was 49.3±11.7 years, while in group B, it was 58.6±9.8 years. In the RLD position, the mean Craniocaudal (CC) diameter showed no significant difference between the two groups. However, the mean Anteroposterior (AP) diameter was higher in group B compared to group A, showing a statistically significant difference (p-value=0.012). Similarly, the mean CSA was significantly higher in group B compared to group A. Regarding gastric volume in the RLD position, the mean volume showed no significant difference between the two groups (p-value=0.342). In the semi-sitting position, the mean CC diameter and AP diameter between the two groups, although not statistically significant, were slightly higher in group B. The mean CSA in group A and group B showed a statistically significant difference. Conclusion: Preoperative intake of clear fluids two hours before surgery showed no significant increase in gastric volume in diabetic patients compared to overnight fasting, as evidenced by ultrasound measurements.

Keywords

• diabetes mellitus
• gastrointestinal emptying
• liquid diet