Effect of pre-operative carbohydrate loading on aspiration risk evaluated with ultrasonography in type 2 diabetes patients: a prospective observational pilot study

Seohee Lee, Jin Young Sohn, Ho-Jin Lee, Susie Yoon, Jae-Hyon Bahk, Bo Rim Kim, Seohee Lee, Jin Young Sohn, Ho-Jin Lee, Susie Yoon, Jae-Hyon Bahk, Bo Rim Kim

Abstract

Owing to concerns about delayed gastric emptying or hyperglycemia, evidence is lacking regarding whether pre-operative carbohydrate loading can be routinely administered to patients with type 2 diabetes. The objective of this study was to determine the aspiration risk and gastric volume after pre-operative carbohydrate loading in patients with type 2 diabetes. A prospective, single-center, observational cohort study. The study was conducted at a tertiary teaching hospital in Seoul, Korea, from May 2020 to May 2021. Patients (n = 49) with type 2 diabetes underwent elective noncardiac surgery. All patients were administered carbohydrate loading two hours before surgery. Once in the operating room, they underwent gastric ultrasonography to determine gastric volume. The anesthesiologists monitored the patients' glucose concentrations during and after surgery. The primary outcome was the predicted risk of aspiration. The secondary outcomes were gastric volume, antral grade, satisfaction score, and perioperative glucose profile. Forty-nine patients were analyzed. All patients had a low risk of aspiration after carbohydrate loading, as follows: 33 (67.3%) patients classified as antral grade 0 and 16 (32.7%) patients classified as antral grade 1. The median time from carbohydrate drink ingestion to ultrasound examination was 120 min (IQR 115-139). After carbohydrate loading, the median gastric volume in the right-lateral position after carbohydrate loading was 2.64 ml (IQR 0.00-32.05). The mean glucose concentrations (SD) were 134 (24) mg/dl, 159 (37) mg/dl, 150 (32) mg/dl, and 165 (36) mg/dl at baseline, after induction, 30 min after surgery, and in the post anesthesia care unit, respectively. The median satisfaction score of the patients was 5 (IQR 4-5). Pre-operative carbohydrate loading may be feasible for patients with type 2 diabetes and without complications.Trial registration: ClinicalTrials.gov (NCT04456166). Registered on 2 July 2020.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Ultrasound image of the gastric antrum in the epigastric area, obtained in the sagittal or parasagittal plane. A, antrum; L, liver; P, pancreas; IVC, inferior vena cava. The antrum is between the left lobe of the liver anteriorly and the pancreas posteriorly at the level of the aorta or the inferior vena cava.
Figure 2
Figure 2
Ultrasound image of the gastric antrum in the epigastric area obtained in a sagittal or parasagittal plane according to gastric contents. The empty antrum (grade 0) is presented (A) in the right lateral decubitus, The antrum with minimal, insignificant amount of fluid (grade 1) appears (B) in the right lateral decubitus; The antrum with significant fluid content (grade 2) is detectable (C) in the right lateral decubitus.
Figure 3
Figure 3
Schematic diagram of the study protocol. RLD, right lateral decubitus; US, ultrasonography; PACU, post anesthesia care unit.; IU, international unit. *Asterisks represent the time points of blood samples for glucose measurement.
Figure 4
Figure 4
The Consolidated Standards of Reporting Trials (CONSORT) diagram of enrolment.

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