Preoperative evaluation of gastric contents and volume using ultrasound in patients with well-controlled and poorly-controlled diabetes mellitus: An observational, cross–sectional study

Document Type

Article

Publication Title

Indian Journal of Clinical Anaesthesia

Abstract

Background and Aims: Aspiration of gastric contents during anaesthesia induction is a critical concern, particularly in diabetic patients who are at risk of delayed gastric emptying due to autonomic neuropathy. The degree of glycemic control may influence gastric motility and, consequently, the gastric volume and contents. Point-of-care ultrasonography (USG) has emerged as a non-invasive, reliable tool for assessing gastric contents and predicting aspiration risk preoperatively. This study aimed to evaluate the gastric contents and volume in patients with well-controlled and poorly controlled diabetes mellitus using bedside ultrasonography (USG) to assess the risk of aspiration during the induction of anaesthesia. Materials and Methods: Sixty adult participants were categorized into two groups: well-controlled diabetes (HbA1c < 8%) and poorly controlled diabetes (HbA1c ≥ 8%), with 30 patients in each group. After overnight fasting of 8 hours, gastric ultrasonography was performed to measure the antral cross-sectional area (CSA) in supine and right lateral decubitus positions and to determine the nature of gastric contents. Patients with gastric contents exceeding safe thresholds or solid content were flagged for potential rapid sequence induction. Results: Poorly controlled diabetics exhibited significantly larger gastric antral CSA and volumes compared to well-controlled diabetics (p < 0.0001). The CSA exceeded the critical threshold of 340 mm² in poorly controlled diabetics, indicating a heightened aspiration risk. In contrast, well-controlled diabetics demonstrated CSA and gastric volumes within safe limits. Conclusion: Preoperative gastric ultrasonography highlighted a greater aspiration risk in poorly controlled diabetics due to larger gastric volumes and contents. This assessment can guide perioperative anaesthesia management, emphasizing the need for tailored induction strategies in this population.

First Page

207

Last Page

214

DOI

10.18231/j.ijca.2025.035

Publication Date

4-1-2025

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