Sastre José A, López Teresa, Julián Roberto, Bustos Domingo, Sanchís-Dux Raquel, Molero-Díez Yaiza B, Sánchez-Tabernero Álvaro, Ruiz-Simón Francisco A, Sánchez-Hernández Miguel V, Gómez-Ríos Manuel Á
From the Department of Anesthesiology, Salamanca University Hospital, Salamanca, Spain.
Department of Anesthesiology, Hospital Virgen de la Concha, Zamora, Spain.
Anesth Analg. 2024 Dec 1;139(6):1300-1308. doi: 10.1213/ANE.0000000000007110. Epub 2024 Aug 8.
Traditionally, diabetics have been considered patients with a high risk of aspiration due to having delayed gastric emptying; However, the evidence concerning residual gastric volume (GV) in fasting diabetic patients is inconsistent. This study aimed to compare the fasting GV of diabetic patients with or without dysautonomia with control patients scheduled for elective surgery using gastric ultrasound.
This bicentric prospective single-blinded case-control study was conducted at 2 university hospitals in Spain. Patients aged over 18 years, classified as American Society of Anesthesiologists (ASA) physical statuses I to III and having similar fasting statuses, were included in the study. The primary outcome was to compare the prevalence of risk stomach using the Perlas gastric content grading scale evaluated by ultrasound in the 3 groups. Secondary outcomes included the measurement of cross-sectional area (CSA) and GV in the right lateral decubitus (RLD) position, as well as the prevalence of solid gastric residue.
A total of 289 patients were recruited for the study, comprising 145 diabetic patients (83 of whom had dysautonomia) and 144 patients in the control group. The percentage of patients classified as Perlas grade 2 was 13.2% in the control group, 16.1% in diabetic patients without dysautonomia, and 22.9% in diabetic patients with dysautonomia ( P = .31). Antral CSA was significantly higher in diabetic patients with dysautonomia (6.5 [4.8-8.4]) compared to the control group (5.4 [4.0-7.2]; P = .04). However, no significant differences were observed between groups in residual GV. Among diabetic patients with dysautonomia, 12% exhibited solid gastric residue, which was twice the percentage observed in diabetic patients without dysautonomia (4.8%) and 3 times higher than that in the control group (3.5%; P = .03). The presence of dysautonomia was associated with an increased odds ratio of solid gastric residue (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.28-8.87; P = .01) after adjusting for confounding factors.
This study offers insights into the relationship between dysautonomia in patients with diabetes mellitus and the presence of full stomach, underscoring the significance of preoperative gastric ultrasound evaluation in managing perioperative risks in this population.
传统上，糖尿病患者因胃排空延迟被视为误吸风险较高的患者；然而，关于空腹糖尿病患者胃残余容积（GV）的证据并不一致。本研究旨在使用胃超声比较有或无自主神经功能障碍的糖尿病患者与择期手术对照组患者的空腹GV。
本双中心前瞻性单盲病例对照研究在西班牙的2所大学医院进行。纳入年龄超过18岁、美国麻醉医师协会（ASA）身体状况分级为I至III且空腹状态相似的患者。主要结局是比较3组中使用超声评估的Perlas胃内容物分级量表评估的风险胃患病率。次要结局包括测量右侧卧位（RLD）时的横截面积（CSA）和GV，以及固体胃残余物的患病率。
共招募289例患者进行研究，包括145例糖尿病患者（其中83例有自主神经功能障碍）和144例对照组患者。对照组中Perlas 2级患者的百分比为13.2%，无自主神经功能障碍的糖尿病患者为16.1%，有自主神经功能障碍的糖尿病患者为22.9%（P = 0.31）。有自主神经功能障碍的糖尿病患者胃窦CSA（6.5 [4.8 - 8.4]）显著高于对照组（5.4 [4.0 - 7.2]；P = 0.04）。然而，各组间残余GV无显著差异。在有自主神经功能障碍的糖尿病患者中，12%出现固体胃残余物，是无自主神经功能障碍的糖尿病患者（4.8%）的两倍，比对照组（3.5%）高3倍（P = 0.03）。在调整混杂因素后，自主神经功能障碍的存在与固体胃残余物的比值比增加相关（比值比[OR]，3.37；95%置信区间[CI]，1.28 - 8.87；P = 0.01）。
本研究深入探讨了糖尿病患者自主神经功能障碍与胃满盈之间的关系，强调了术前胃超声评估在管理该人群围手术期风险中的重要性。
