Kernekoncepter
Patients with diabetes do not have significantly higher gastric volumes compared to non-diabetic patients after following standard preoperative fasting instructions, suggesting that different fasting guidelines may not be necessary.
Resumé
The study examined 84 people with diabetes (85% with type 2) and 96 without diabetes, all with a BMI < 40, who were undergoing elective surgery. After following standard preoperative fasting guidelines, a gastric ultrasound was used to assess their gastric contents.
The key findings are:
- There was no significant difference in gastric volume between the two groups (0.81 mL/kg with diabetes vs 0.87 mL/kg without).
- The proportion with "full stomach" (any solid content or > 1.5 mL/kg of clear fluid) was also similar (15.5% with diabetes vs 11.5% without).
- The lead author suggests that the standard fasting instructions seem to be effective in assuring an empty stomach for most diabetic patients, and different fasting guidelines are generally not needed.
However, an expert endocrinologist disputed the study's conclusions, noting that the participants were healthier than the general diabetes population and may not be representative. The expert also criticized the current ASA fasting guidelines for allowing clear liquids up to 2 hours before surgery, as this can still leave some residual stomach contents.
Additionally, the widespread use of GLP-1 receptor agonists for diabetes and weight loss, which can delay gastric emptying, was not addressed in the study. The experts suggest that this new factor may require re-evaluation of the current fasting guidelines, particularly for patients taking these medications.
Statistik
0.81 mL/kg gastric volume in patients with diabetes
0.87 mL/kg gastric volume in patients without diabetes
15.5% of patients with diabetes had "full stomach"
11.5% of patients without diabetes had "full stomach"
Citater
"We never change practice completely based on a single study, but I think in general, based on our findings, that most diabetic patients aren't any different from nondiabetics when it comes to their gastric content after fasting, and our standard fasting instructions seem to be just as effective in assuring an empty stomach."
"They've picked the wrong group of diabetics. This is not a group where you would expect a very high prevalence of delayed emptying."
"Whether you have diabetes or not, if you are allowed to have a sugar drink up to 2 hours before your operation, the majority of people empty at about 4 kcal/min, so they will still have some of that drink in their stomach. If you want an empty stomach, the ASA guidelines are wrong."