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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 893-898. doi: 10.19723/j.issn.1671-167X.2023.05.018

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Effect of preoperative carbohydrates intake on the gastric volume and the risk of reflux aspiration in patients positioning in trendelenburg undergoing gynecological laparoscopic procedures

Yue WEI1,Xi LU1,Jing ZHANG2,Kun-peng LIU1,Yong-jun WANG2,Lan YAO1,*()   

  1. 1. Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
    2. Department of Gynecology, Peking University International Hospital, Beijing 102206, China
  • Received:2022-04-08 Online:2023-10-18 Published:2023-10-09
  • Contact: Lan YAO E-mail:Yaolan@pkuih.edu.cn
  • Supported by:
    Peking University International Hospital Research Grant(YN2018ZD03)

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Abstract:

Objective: To investigate the effect of 300 mL carbohydrates intake two hours before sur-gery on the gastric volume (GV) in patients positioning in trendelenburg undergoing gynecological laparoscopic procedures by using gastric antrum sonography, and further assess the risk of reflux aspiration. Methods: From June 2020 to February 2021, a total of 80 patients, aged 18–65 years, body mass index (BMI) 18–35 kg/m2, falling into American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, scheduled for gynecological laparoscopic procedures positioning in trendelenburg were recruited and divided into two groups: the observation group (n =40) and the control group (n=40). In the observation group, solid food was restricted after 24:00, the patients were required to take 300 mL carbohydrates two hours before surgery. In the control group, solid food and liquid intake were restricted after 24:00 the night before surgery. The cross-sectional area (CSA) of gastric antrum was measured in supine position and right lateral decubitus position before anesthesia. Primary outcome was gastric volume (GV) in each group. Secondary outcome included Perlas A semi-quantitative grading and gastric volume/weight (GV/W). All the patients received assessment of preoperative feeling of thirsty and hunger with visual analogue scale (VAS). Results: Complete data were available in eighty patients. GV was (58.8±23.6) mL in the intervention group vs. (56.3±22.1) mL in the control group, GV/W was (0.97±0.39) mL/kg vs. (0.95±0.35) mL/kg, respectively; all the above showed no significant difference between the two groups (P > 0.05). Perlas A semi-quantitative grading showed 0 in 24 patients (60%), 1 in 15 patients (37.5%), 2 in 1 patient (2.5%) in the intervention group and 0 in 25 (62.5%), 1 in 13 (32.5%), 2 in 2 (5%) in the control group, the proportion of Perlas A semi-quantitative grading showed no significant difference between the two groups (P > 0.05). A total of 3 patients (1 in the intervention group and 2 in the control group) with Perlas A semi-quantitative grading 2 were treated with special intervention, no aspiration case was observed in this study. The observation group endured less thirst and hunger (P＜0.05). Conclusion: Three hundred mL carbohydrates intake two hours before surgery along with ultrasound guided gastric content monitoring does not increase gastric volume and the risk of reflux aspiration in patients positioning in trendelenburg undergoing gynecological laparoscopic surgery, and is helpful in minimizing disturbance to the patient's physiological needs, therefore leading to better clinical outcome.

Key words: Gastric ultrasonography, Gastric volume, Fasting, Enhanced recovery surgery, Trendelenburg position

CLC Number: 

  • R614

Figure 1

The sonoanatomic image of the stomach when empty stomach with collapsed pylorus A, antrum; L, liver; Ao, aorta."

Figure 2

The sonoanatomic image of the stomach filled with clear liquids A, antrum; L, liver; Ao, aorta."

Table 1

The demographics of patients in two groups"

Items Intervention group (n=40) Control group (n=40) Statistical value P
Age/years, ${\bar x}$±s 40±10 42±10 t=1.115 0.268
Height/cm, ${\bar x}$±s 161±5 162±4 t=1.193 0.236
Weight/kg, ${\bar x}$±s 61.4±8.9 59.2±8.2 t=－1.170 0.245
BMI/(kg/m2), ${\bar x}$±s 23.8±3.5 22.6±3.2 t=0.340 0.113
ASA, Ⅰ/Ⅱ 15/25 22/18 χ2=2.464 0.116
Patients combined diabetes, n (%) 3 (7.5) 4 (10) 1.000

Table 2

Main ultrasound data and Perlas A grading scale in two groups"

Items Intervention group (n=40) Control group (n=40) Statistical value P
CSA in supine/(mm2), ${\bar x}$±s 378±111 384±114 t=0.263 0.793
CSA in RLD/(mm2), ${\bar x}$±s 566±173 572±163 t=0.167 0.868
Gastric volume/mL, ${\bar x}$±s 58.8±23.6 56.3±22.1 t=－0.491 0.625
GV/W/(mL/kg), ${\bar x}$±s 0.97±0.39 0.95±0.35 t=－0.170 0.865
Perlas A grade, n (%) Z=－0.130 0.897
    0 24 (60) 25 (62.5)
    1 15 (37.5) 13 (32.5)
    2 1 (2.5) 2 (5)

Table 3

Comparison of fasting time and thirst VAS and starvation VAS in two groups"

Items Intervention group (n=40) Control group (n=40) Statistical value P
Fasting for clear liquids/h, ${\bar x}$±s 3.1±1.3 12.2±1.9 t=25.553 < 0.001
Fasting for solids/h, ${\bar x}$±s 14.8±3.6 14.7±2.5 t=－0.127 0.900
Thirst VAS, M (min，max) 2 (2, 2) 5 (3, 5) Z=－7.350 < 0.001
Starvation VAS, M (min，max) 1 (0, 2) 3 (3, 3) Z=－6.920 < 0.001

Table 4

Intraoperative conditions and complications of the two groups"

Items Intervention group (n=40) Control group (n=40) Statistical value P
MAP at T0/mmHg, ${\bar x}$±s 89±9 92±9 t=－1.668 0.099
HR at T0/(/min), ${\bar x}$±s 77±12 73±12 t=0.580 0.564
MAP at T1/mmHg, ${\bar x}$±s 80±12 83±9 t=－1.114 0.269
HR at T1/(/min), ${\bar x}$±s 66±12 64±10 t=0.583 0.562
MAP at T2/mmHg, ${\bar x}$±s 78±11 79±8 t=－0.739 0.462
HR at T2/(/min), ${\bar x}$±s 64±12 63±11 t=0.517 0.607
Surgery time/min, ${\bar x}$±s 126±69 104±75 t=1.350 0.181
Anesthesia time/min, ${\bar x}$±s 178±79 144±86 t=1.809 0.074
Fluid infusion volume/mL, ${\bar x}$±s 1 208±431 1 143±237 t=0.836 0.406
Bleeding volume/mL, ${\bar x}$±s 64±40 56±31 t=0.975 0.332
The treatment of ephedrine, n (%) 5 (12.5) 7 (17.5) χ2=0.392 0.531
The incidence of PONV, n (%) 7 (17.5) 8 (20) χ2=0.082 0.775
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