Preoperative Gastric Ultrasound to Assess Stomach Contents and Aspiration Risk in Patients With Diabetes
Distribution of Residual Gastric Volume Assessed by Preoperative Gastric Ultrasound, Aspiration Risk, and Related Factors in Diabetic Patients Undergoing Elective Surgery: A Prospective Observational Study
Diabetes can slow down stomach emptying. As a result, some patients with diabetes may still have food or fluid in their stomach before surgery, even after following standard fasting rules. This can increase the risk of stomach contents entering the lungs (pulmonary aspiration) during anesthesia.
The aim of this prospective observational study is to measure the amount of residual stomach content using bedside gastric ultrasound in adult patients with type 1 or type 2 diabetes scheduled for elective surgery under general anesthesia. The study will also determine how often a high aspiration risk is present and identify clinical factors associated with it, including HbA1c level, duration of diabetes, use of GLP-1 receptor agonists, insulin use, fasting duration, and gastroparesis symptoms.
Gastric ultrasound is non-invasive, painless, and does not involve radiation. No drug or additional intervention will be given as part of this study. Patients found to be at high aspiration risk will be reported to the responsible anesthesiologist.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
This is a prospective, observational, single-center study to be conducted at the University of Health Sciences Gazi Yasargil Training and Research Hospital. Approximately 130 adult patients (aged 18-80 years, ASA physical status I-III) with type 1 or type 2 diabetes mellitus scheduled for elective surgery under general anesthesia will be enrolled after written informed consent.
Each patient will be assessed at a single time point in the preoperative holding area before induction of anesthesia. Gastric ultrasound will be performed in the supine and right lateral decubitus positions. The anteroposterior and craniocaudal diameters of the gastric antrum will be measured, and the antral cross-sectional area (CSA) will be calculated. Gastric volume (GV) will be estimated using the Perlas formula [GV (mL) = 27 + 14.6 x CSA - 1.28 x age] and normalized to body weight (mL/kg). Gastric content will be classified according to the Perlas grading system (Grade 0-2). Patients with Perlas Grade 2 and/or GV >1.5 mL/kg will be classified as having high aspiration risk.
Demographic data, diabetes-related clinical parameters (type and duration of diabetes, HbA1c, fasting blood glucose, insulin and oral antidiabetic use), details of GLP-1 receptor agonist use (drug, dose, frequency, and time since last dose), preoperative fasting durations, and gastroparesis symptoms assessed with the Gastroparesis Cardinal Symptom Index (GCSI) will be recorded by a second investigator.
To minimize measurement bias, the ultrasound examination will be performed by a single trained anesthesiologist blinded to the patients' clinical data, while the investigator collecting clinical data will be blinded to the ultrasound findings.
Patients will be followed for 24-48 hours postoperatively through medical records for postoperative nausea and vomiting, fever, cough, dyspnea, pulmonary infiltrates on chest radiography, and clinical signs of aspiration pneumonia.
Factors associated with high aspiration risk will be analyzed using univariable and multivariable logistic regression. Correlations between gastric volume and HbA1c, diabetes duration, fasting duration, and GCSI score will be assessed using Pearson or Spearman correlation.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: RENİM YÜKSEL, MD
- Telefonnummer: +90 0538 474 80 39
- E-mail: renimbarut@hotmail.com
Studiesteder
-
-
Diyarbakır
-
Diyarbakır, Diyarbakır, Tyrkiet (Türkiye), 21070
- University of Health Sciences Gazi Yasargil Training and Research Hospital
-
Kontakt:
- RENİM YUKSEL, MD
- Telefonnummer: +90 0538 474 80 39
- E-mail: renimbarut@hotmail.com
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Prøveudtagningsmetode
Studiebefolkning
Adult patients with type 1 or type 2 diabetes mellitus scheduled for elective surgery under general anesthesia at the University of Health Sciences Gazi Yasargil Training and Research Hospital.
Beskrivelse
Inclusion Criteria:
- Age 18-80 years
- Diagnosis of type 1 or type 2 diabetes mellitus
- Scheduled for elective surgery under general anesthesia
- ASA physical status I-III
- Written informed consent
Exclusion Criteria:
- Emergency surgery
- Pregnancy
- History of upper gastrointestinal surgery
- Known gastrointestinal obstruction
- Known severe gastroparesis
- Inadequate gastric ultrasound image quality
- Refusal to provide consent
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Observationsmodeller: COHORT
- Tidsperspektiver: PROSPECTIVE
Antal grupper/kohorter
Kohorter og interventioner
Gruppe / kohorteGruppe / kohorte |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Diabetic Patients Undergoing Elective Surgery
dult patients (18-80 years, ASA physical status I-III) with type 1 or type 2 diabetes mellitus scheduled for elective surgery under general anesthesia, who will undergo a single preoperative gastric ultrasound assessment and 24-48 hours of postoperative follow-up for clinical signs of aspiration. |
Bedside gastric ultrasound performed in the supine and right lateral decubitus positions in the preoperative holding area before induction of anesthesia. The antral cross-sectional area will be measured, gastric volume will be calculated using the Perlas formula and normalized to body weight (mL/kg), and gastric content will be classified using the Perlas grading system. The examination is non-invasive and part of a single assessment; no drug or treatment is administered. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Residual Gastric Volume Assessed by Preoperative Gastric Ultrasound
Tidsramme: Preoperatively, before induction of anesthesia (single assessment)
|
Gastric ultrasound will be performed in both the supine and right lateral decubitus positions. Gastric volume will be estimated from the antral cross-sectional area measured in the right lateral decubitus position using the Perlas formula [GV (mL) = 27 + 14.6 x CSA - 1.28 x age] and normalized to body weight (mL/kg). The distribution of residual gastric volume will be reported as mean, standard deviation, median, interquartile range, and minimum-maximum values. |
Preoperatively, before induction of anesthesia (single assessment)
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Prevalence of High Aspiration Risk
Tidsramme: Preoperatively, before induction of anesthesia (single assessment)
|
Proportion of patients classified as having high aspiration risk, defined as Perlas Grade 2 (fluid visible in both supine and right lateral decubitus positions) and/or gastric volume >1.5 mL/kg. Prevalence will be reported with 95% confidence interval |
Preoperatively, before induction of anesthesia (single assessment)
|
|
Correlation Between HbA1c and Gastric Volume
Tidsramme: Preoperatively, before induction of anesthesia (single assessment)
|
Correlation between preoperative HbA1c level (%) and weight-normalized gastric volume (mL/kg), assessed using Pearson or Spearman correlation coefficient. |
Preoperatively, before induction of anesthesia (single assessment)
|
|
Correlation Between Diabetes Duration and Gastric Volume
Tidsramme: Preoperatively, before induction of anesthesia (single assessment)
|
Correlation between duration of diabetes mellitus (years) and weight-normalized gastric volume (mL/kg), assessed using Pearson or Spearman correlation coefficient. |
Preoperatively, before induction of anesthesia (single assessment)
|
|
Effect of GLP-1 Receptor Agonist Use and Timing of Last Dose on Gastric Volume
Tidsramme: Preoperatively, before induction of anesthesia (single assessment)
|
Weight-normalized gastric volume (mL/kg) compared between GLP-1 receptor agonist users and non-users. Among users, gastric volume will be compared between patients whose last dose was taken ≤7 days and >7 days before the preoperative assessment |
Preoperatively, before induction of anesthesia (single assessment)
|
|
Effect of Insulin Use on Gastric Volume
Tidsramme: Preoperatively, before induction of anesthesia (single assessment)
|
Weight-normalized gastric volume (mL/kg) compared between patients using and not using insulin therapy. |
Preoperatively, before induction of anesthesia (single assessment)
|
|
Correlation Between Preoperative Fasting Duration and Gastric Volume
Tidsramme: Preoperatively, before induction of anesthesia (single assessment)
|
Correlation between preoperative solid and clear fluid fasting durations (hours) and weight-normalized gastric volume (mL/kg), assessed using Pearson or Spearman correlation coefficient. |
Preoperatively, before induction of anesthesia (single assessment)
|
|
Correlation Between Gastroparesis Cardinal Symptom Index (GCSI) Score and Gastric Volume
Tidsramme: Preoperatively, before induction of anesthesia (single assessment)
|
Correlation between total GCSI score (range 0-5, higher scores indicate more severe gastroparesis symptoms) and weight-normalized gastric volume (mL/kg), assessed using Pearson or Spearman correlation coefficient. |
Preoperatively, before induction of anesthesia (single assessment)
|
|
Incidence of Postoperative Clinical Aspiration
Tidsramme: Up to 48 hours after surgery
|
Number of patients developing clinical signs of pulmonary aspiration (fever, cough, dyspnea, new pulmonary infiltrate on chest radiography) or aspiration pneumonia, and postoperative nausea and vomiting, assessed from medical records. |
Up to 48 hours after surgery
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: RENİM YÜKSEL, MD, University of Health Sciences, Gazi Yasargil Training and Research Hospital
Publikationer og nyttige links
Generelle publikationer
- Perlas A, Mitsakakis N, Liu L, Cino M, Haldipur N, Davis L, Cubillos J, Chan V. Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesth Analg. 2013 Feb;116(2):357-63. doi: 10.1213/ANE.0b013e318274fc19. Epub 2013 Jan 9.
- Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009 Jul;111(1):82-9. doi: 10.1097/ALN.0b013e3181a97250.
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Neurologiske manifestationer
- Sygdomme i det endokrine system
- Patologiske processer
- Metaboliske sygdomme
- Luftvejssygdomme
- Sygdomme i fordøjelsessystemet
- Gastrointestinale sygdomme
- Mavesygdomme
- Respirationsforstyrrelser
- Glukosemetabolismeforstyrrelser
- Lammelse
- Patologiske tilstande, tegn og symptomer
- Ernæringsmæssige og metaboliske sygdomme
- Tegn og symptomer
- Diabetes mellitus
- Respiratorisk aspiration
- Gastroparese
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 441
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
Individual participant data will not be shared due to patient confidentiality and data protection regulations. Aggregate results will be reported in the publication.
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