Risk Assessment Of Oral Carbohydrate Aspiration By Diabetic Patients Under The Concept Of ERAS

Objective Preoperative oral carbohydrate?POC?,as one of the key measures of enhanced recovery after surgery,does bring a lot of benefits to patients,but the safety of oral carbohydrates for diabetes patients before operation needs to be further studied.Point-of-care ultrasound was used to evaluate gastric emptying of oral carbohydrate drinks before surgery in patients with type 2 diabetes undergoing elective surgery.Methods Patients with type 2 diabetes and patients without diabetes who underwent elective surgery in the affiliated hospital of Inner Mongolia medical university in 2018-2019,male or female,aged 18-75 years,BMI<35kg/m2,ASA physical status I-III,were continuously included,and divided into diabetic group and non-diabetic group,with 20 patients in each group.All patients participated voluntarily and signed informed consent.After a standard overnight fast,two groups of patients underwent a standardised gastric ultrasound assessment at baseline at 8:00AM on the day before the scheduled surgery and ultrasound examination of gastric antrum was performed again at 400ml of oral carbohydrate drink for 2h to assess gastric emptation.The gastric antrum sectional area?CSA?,gastric volume?V?,Perlas score and the incidence of delayed gastric emptation were compared between the two groups after carbohydrate drinks consumption in the semi-sitting position and the right lateral positions.The delay of gastric emptying was defined as the gastric volume of>1.5ml/kg at the intake of 400ml 2h carbohydrate drinks.The related complications and upper gastrointestinal symptoms of patients in the diabetes group were recorded.Multivariate analyses were performed for the risk factors of delayed gastric emptying in the diabetes group.Results A total of 120 patients completed the study and were included in the analysis?60 in the diabetic group and 60 in the non-diabetic group?.After drinking carbohydrate drinks for 2hours,the cross-sectional area of gastric antrum?CSA₁?and right lateral gastric volume?V₁?of the diabetic group were both higher than those of the non-diabetic group?P<0.001?.The proportion of patients with delayed gastric emptying in the diabetic group?43.33%?was higher than that in the non-diabetic group?8.33%?.Multivariate regression analysis showed that compared with men,women?OR=4.426,95%CI:1.373?14.263?had a higher risk of delayed gastric emptying.The risk of delayed gastric emptying in type 2 diabetic patients with symptoms of abdominal bloating/fullness was 5.353 times higher than that in asymptomatic patients?OR=4.471,95%CI:1.129?17.699?.Women and abdominal bloating/fullness are risk factors for delayed gastric emptying in patients with type 2 diabetes who consume carbohydrates before surgery.Conclusion Compared with non-diabetic patients,patients with type 2 diabetes had higher gastric antrum cross-sectional area and gastric volume at 2h of carbohydrate intake.Considering the adverse effects of excessive fasting on postoperative patients with diabetes,it is recommended to adopt ERAS'preoperative recommendation of fasting for carbohydrate consumption in patients with diabetes,which can be used to evaluate gastric emptying by gastric antrum ultrasound examination before anesthesia or appropriately extend the fasting time to reduce the occurrence of aspiration during anesthesia.Women and abdominal bloating/fullness are risk factors of gastric retention in patients with type 2 diabetes who undergo ERAS clinical protocols after drinking carbohydrate.During the implementation of ERAS preoperative fasting regimen,the risk of aspiration should be carefully evaluated before anesthesia and a safe anesthesia management program should be developed for such patients.