Preoperative Ultrasonographic Comparison of Fasting

Gastric Volume In Diabetic &  Non-Diabetic Patients :

Prospective Analytical Observational Study

Candidate: Dr Eldho Joy

Junior resident

Department of Anaesthesiology

Goa Medical College , Bambolim ,Goa

Guide: Dr Shirley Ann D’Souza

Professor and HOD

Department of Anaesthesiology

Goa Medical College , Bambolim ,Goa

Introduction

• Point of care gastric ultrasonography is a simple,

readily available, non invasive & easy to perform

diagnostic tool to examine the volume of gastric

content and determine pulmonary aspiration risk

• Data on fasting gastric content and volume in

preoperative patients with Diabetes Mellitus is

limited and contradictory . Hence the present

study

Aim & Objectives

• Research Question: Whether the gastric volume is

more than the safe limit in diabetic as compared

to non - diabetic patients despite adequate

fasting?

• Primary objective – To determine and compare

the residual gastric volume in preoperative

diabetic and non-diabetic patients.

• Secondary objective –To study the fasting gastric

volume in relation to

1.Control of diabetes in terms of HbA1c &

2. Duration of diabetes.

Materials and Methods

• Study design – Prospective, Analytical

Observational study

• Study Setting – Preoperative Area Of Operation

Theatre in Goa Medical College

• Study Duration – March 2024 - March 2025

• Sampling Method – Universal Sampling

• Sample Size – Total 80 (40 Diabetic & 40 Non-

Diabetic)

n = sample size

All statistical calculation will be done using SPSS

software .

Inclusion Criteria

• Patients scheduled for elective surgery with

preoperative fasting period of 8-10 hours

• Age: 18-65 years

• Sex: Either sex

• ASA physical status: I, II

• Body mass index < 30kg/m 2

Exclusion Criteria

• Pregnant patient

• Gastroesophageal reflux disease

• Recent abdominal trauma/ previous

gastrointestinal surgery

• Patients who are unable to turn & lie in right

lateral position

• Patients with nasogastric tube in situ

• Conditions/ drugs that alter gastric emptying

Procedure

Patients will be divided into 2 groups based on

diagnosis of Diabetes Mellitus

Group A (Diabetic)

Group B (Non Diabetic)

• Ultrasonography in preoperative waiting area will

be done with

• A portable ultrasound machine with curved array

low frequency (2-5MHz) probe.

• The epigastrium will be scanned in sagittal plane in

Supine position followed by Right Lateral

Decubitus (RLD) position.

The gastric antrum is identified just below the left lobe

of liver and pancreas where the aorta and inferior vena

cava serve as important vascular landmark.

The sonographic appearance of gastric antrum is

classified as

Grade 1-empty antrum

Grade 2-fluid detected in right lateral position only

Grade 3-antral fluid in both supine and right lateral

position

Empty Antrum - Bulls-eye’ appearance

Thick muscularis propria layer

Clear fluid - Hypoechoic ,distended antrum

Gastric antrum

(A) containing fluid with some air bubbles

(B) containing fluid with ‘starry night’ appearance

Solids- distended antrum

(C) After recent ingestion of solids, with a ‘frosted

glass’ appearance.

(D) Gastric antrum containing solids, in later stage

shows hyperechoic heterogeneous consistency

representing different consistency of solids consumed

Quantitative Assessment

• Cross-sectional area (CSA) is calculated by using

two perpendicular diameters :

Antero-Posterior(AP) &amp; Cranio-Caudal (CC) &amp;

the formula CSA=( AP x CC x Ï€ ) /4

Perlas formula

Gastric residual volume(ml) =

27.0+ 14.6 x right lateral CSA – 1.28 x age

PATIENTS INFORMATION SHEET

Title - Preoperative Ultrasonographic Comparison of Fasting Gastric Volume In Diabetic &amp; Non-

Diabetic Patients.

Introduction – We would like to invite you to participate in the research project . Before you

decide you need to understand why the research is being done and what will it involve for you.

Please read this information sheet carefully and ask questions about anything you do not

understand .You can also talk to others before you decide.

Purpose of the study- To determine and compare the residual gastric volume in preoperative

diabetic and non-diabetic patients.

Whether the gastric volume is more than the safe limit in diabetic as compared to non - diabetic

patients despite adequate fasting.

Risks to you- no risk.

Benefits to you- Based on the results of the study , we will be able to examine stomach contents

and determine pulmonary aspiration risk by a non invasive way.

.Participating in the study will not provide you any financial or medical benefit.

Confidentiality-

All data collected will be kept confidential.

Do I have to take part ? - You will be included in the study only after voluntary consent.

Your right to withdraw-

Its not compulsory that you have to participate in the study .Even after your consent for the study

,you are free to withdraw from it at any given point of time.

If you have any problems or questions regarding the study ,please feel free to contact any of the

investigator whose details are given below .

Problems or Questions -

You will be given a copy of this form .If you have any problems or questions regarding the study

,please feel free to contact any of the investigator whose details are given below . You will be asked

to provide your contact details so that the study organizers can contact you.

Investigators details – Dr Eldho Joy, Junior Resident.

Phone number- 8552837062

Address- GARD Hostel , Goa medical college, Bambolim, Goa .

In case of any ethical issue please contact- Member Secretary, Institutional Ethical Committee, Goa

Medical College, Goa.

CONSENT FORM FOR PARTICIPANTS

I             ,confirm that I have read and understood the participants information sheet

for the above study titled as ‘Preoperative Ultrasonographic Comparison of

Fasting Gastric Volume In Diabetic & Non-Diabetic Patients ‘.

I am aware that my participation in this study is voluntary and I have the right to withdraw

from this study at any point of time without stating my reasons for it and without my right

being affected.

I understand that all information collected from me will be kept strictly confidential and no

information will be given to anyone including institutional authorities, apart from the study

investigators.

I understand that this study will involve :

Collection of my personal and clinical details.

Collection of investigational reports.

I understand that the information I provide will be used only to fulfill the above stated

objective and will not be used in any way that is harmful or discriminatory against me.

I agree that the data or the results that arise from the study can be used for a scientific

purpose . I understand that there are no monetary benefits to me from this study.

Signature of the participant / custodian-

Name of the participant / custodian-

Signature of witness –

Signature of the Investigator-

Name and details of investigator –

Contact number of investigator-

Date-

Time-

PROFORMA

Hospital registration number:

Date

                                                         DIABETIC                                   NON DIABETIC

Age

Sex

ASA –PS

Weight

Height

BMI

Years since

diagnosis of DM

Medication

Insulin

OHA

Insulin & OHA

HbA1c

Creatinine

DM neuropathy

Hours of fasting

solid

Liquid

USG

Grade 1

Grade 2

Grade 3

Antero-

Posterior(AP)

Diameter

(Right Lateral)

Cranio-Caudal (CC)

Diameter

CSA=

Gastric residual

volume(ml) =

27.0+ 14.6 x right

lateral CSA – 1.28 x

age

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