Haramgatti Avinash, Sharma Sanjeev, Kumar Amit, Jilowa Sarita
Department of Anaesthesiology and Critical Care, ABVIMS and Dr. RML Hospital, New Delhi, India.
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Saudi J Anaesth. 2022 Jul-Sep;16(3):355-360. doi: 10.4103/sja.sja_223_22. Epub 2022 Jun 20.
The presence of gastric content increases the risk of aspiration during general anesthesia. Diabetic patients have delayed gastric emptying; however, despite adequate fasting because of diabetic gastroparesis these patients have a high risk of aspiration. This study aimed to compare ultrasound-guided measurement of residual gastric volume between diabetic and non-diabetic patients scheduled for elective surgery under general anesthesia.
This prospective observational study included 80 patients divided into two groups of 40 diabetic patients with a minimum of 8 years history of diabetes and 40 nondiabetic patients aged >18 years, American Society of Anesthesiologists' physical status I-II kept with similar fasting intervals. Before induction of general anesthesia, gastric ultrasound was performed using standard gastric scanning protocol to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross-sectional area (CSA) and gastric volume in semi-sitting (SS) and right lateral decubitus (RLD) position using curved array probe. The gastric antrum volume (GV) was classified as Grade 0, 1, or 2, and risk stratification for aspiration was done. The nasogastric tube was inserted after induction of anesthesia to aspirate and compare the gastric content.
In the semi-sitting position, the mean CC and AP diameters were 16.38 ± 3.31 mm and 10.1 ± 2.53 mm in the non-diabetic group and 25.19 ± 4.08 mm and 15.8 ± 3.51 mm in the diabetic group, respectively. In RLD, CC was 1.91 ± 0.38 cm and AP was 1.19 ± 0.34 cm in the non-diabetic group as compared to the CC of 2.78 ± 0.4 cm and AP of 1.81 ± 0.39 cm in the diabetic group. The calculated CSA of 318.23 ± 97.14 mm and 4 ± 1.1 cm in diabetic were significantly higher than 133.12 ± 58.56 mm and 1.83 ± 0.83 cm of non-diabetic, in SS ( < 0.0001) and RLD ( < 0.0001) positions, respectively. The GV of 15.48 ± 11.18 ml in the diabetic group was significantly higher than (-) 9.77 ± 18.56 ml in the non-diabetic group ( < 0.0001). Despite the differences in CSA and GV between diabetic and non-diabetic groups, both groups showed a low gastric residual volume (<1.5 ml/kg). The gastric tube aspirate in the non-diabetic and diabetic groups was 0.3 ± 0.78 ml and 1.24 ± 1.46 ml, respectively, and was statistically significant ( = 0.0006).
Patients with long-standing diabetes showed higher gastric residual and antral CSA when compared with non-diabetic patients. The clinical significance of these findings needs further evidence for the formulation of specific guidelines for diabetic patients.
胃内容物的存在会增加全身麻醉期间误吸的风险。糖尿病患者胃排空延迟；然而，尽管因糖尿病性胃轻瘫进行了充分禁食，这些患者仍有较高的误吸风险。本研究旨在比较超声引导下测量计划接受全身麻醉择期手术的糖尿病患者和非糖尿病患者的残余胃容量。
这项前瞻性观察性研究纳入了80例患者，分为两组，40例糖尿病患者，糖尿病病史至少8年，40例非糖尿病患者，年龄>18岁，美国麻醉医师协会身体状况分级为I-II级，禁食时间相似。在全身麻醉诱导前，使用标准胃扫描方案进行胃超声检查，测量头尾径（CC）和前后径（AP），然后使用弯阵探头计算半卧位（SS）和右侧卧位（RLD）时胃窦横截面积（CSA）和胃容量。将胃窦容积（GV）分为0级、1级或2级，并进行误吸风险分层。麻醉诱导后插入鼻胃管抽吸并比较胃内容物。
在半卧位时，非糖尿病组的平均CC和AP直径分别为16.38±3.31mm和10.1±2.53mm，糖尿病组分别为25.19±4.08mm和15.8±3.51mm。在RLD位，非糖尿病组的CC为1.91±0.38cm和AP为1.19±0.34cm，而糖尿病组的CC为2.78±0.4cm和AP为1.81±0.39cm。在SS位（<0.0001）和RLD位（<0.0001），糖尿病组计算出的CSA分别为318.23±97.14mm和4±1.1cm，显著高于非糖尿病组的133.12±58.56mm和1.83±0.83cm。糖尿病组的GV为15.48±11.18ml，显著高于非糖尿病组的（-）9.77±18.56ml（<0.0001）。尽管糖尿病组和非糖尿病组在CSA和GV上存在差异，但两组的胃残余容量均较低（<1.5ml/kg）。非糖尿病组和糖尿病组的胃管抽吸量分别为0.3±0.78ml和1.24±1.46ml，差异有统计学意义（=0.0006）。
与非糖尿病患者相比，长期糖尿病患者的胃残余量和胃窦CSA更高。这些发现的临床意义需要进一步的证据来制定针对糖尿病患者的具体指南。
