Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study

Feb 16, 2021Anesthesia and analgesia

Using Ultrasound to Compare How Quickly Stomach Empties Pre-Surgery Carbohydrate Drinks

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Abstract

Gastric antral cross-sectional area (CSA) was similar in both the NPO group and the NO-NPO group, measuring 6.25 ± 3.79 cm2 and 6.21 ± 2.48 cm2, respectively.

The mean difference in CSA between the NO-NPO and NPO groups was 0.04 cm2, falling within the noninferiority margin of 2.8 cm2.
Gastric volume (GV) was not significantly different between the NPO group (70 ± 56 mL) and the NO-NPO group (66 ± 36 mL).
Gastric volume per weight (GV/kg) showed no significant difference, with NPO at 1.25 ± 1.00 mL/kg and NO-NPO at 1.17 ± 0.67 mL/kg.
The incidence of GV/kg greater than 1.5 mL/kg was not different between groups, with 31.3% in the NPO group and 21.9% in the NO-NPO group.
The Perlas grade, which assesses gastric content, was similar in both groups, with medians of 1 (0-1) for NPO and 0.5 (0-1) for NO-NPO.

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BACKGROUND: Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group.

METHODS: Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA <2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg >1.5 mL/kg, and Perlas grade.

RESULTS: CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group - NPO group) was 0.04 (95% confidence interval [CI], -1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, -20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg > 1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0-1) in NPO group and 0.5 (0-1) in NO-NPO group (P = .871).

CONCLUSIONS: Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.

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Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study

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