Gastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: an observational study

Sep 2, 2019International journal of obstetric anesthesia

How carbohydrate drinks leave the stomach in full-term women before planned C-section

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Abstract

All participants returned to a qualitative fasted grade by 100 minutes after consuming 400 mL of a carbohydrate drink.

Gastric emptying was assessed in 40 non-labouring pregnant women prior to elective caesarean delivery.
At baseline, all participants had a qualitative grade of either 0 or 1.
By 120 minutes, the antral right lateral decubitus cross-sectional area was 8.03 cm and gastric volume per kg was 1.57 mL/kg.
There was no statistically significant difference from baseline in either the cross-sectional area (P=0.38) or gastric volume per kg (P=0.27).
This finding suggests that the carbohydrate drink can be safely consumed up to two hours before elective surgery.

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BACKGROUND: Pre-operative carbohydrate (CHO) drinks have shown some benefits peri-operatively and have been incorporated into many Enhanced Recovery after Surgery (ERAS) programmes. We assessed the gastric emptying of pre-operative CHO drinks prior to elective caesarean delivery using ultrasonography.

METHODS: After a standard overnight fast, non-labouring pregnant women awaiting elective caesarean delivery underwent a standardised gastric ultrasound assessment at baseline and then every 20 min for 2 h after consuming 400 mL of a CHO drink. The gastric emptying was determined at each time-point both qualitatively and quantitatively. The primary outcome was the time taken for participants to return to a qualitative fasted Perlas grade of 0 or 1.

RESULTS: The gastric emptying of 40 participants was analysed. At baseline, all patients had a qualitative grade of either 0 or 1. All patients had returned to either grade 0 or 1 by 100 min. At 120 min the antral right lateral decubitus (RLD) cross-sectional area (CSA) was 8.03 cm(95th percentile; 95% CI 7.4 to 8.3 cm) and gastric volume per kg was 1.57 mL/kg (95th percentile; 95% CI 1.4 to 2.2). At 120 min there was no statistically significant difference from baseline for the RLD CSA (P=0.38) or gastric volume per kg (P=0.27). 2 2

CONCLUSIONS: The gastric emptying of this cohort of pregnant women suggests that 400 mL of a CHO drink can be safely consumed up to two hours before elective surgery. This study can help inform future peri-operative fasting guidelines for pregnant patients.

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Gastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: an observational study

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