Type 2 Diabetes Mellitus: Relationships Between Preoperative Physiologic Stress, Gastric Content Volume and Quality,...

Pulmonary aspiration is a potentially fatal anesthetic complication occurring when gastric contents enter the respiratory system. Fasting guidelines aim to decrease the risk of pulmonary aspiration by recommending a timeframe in which patients abstain from food and drink before surgery. Fasting guidelines recommended for healthy individuals fail to account for patients with type 2 diabetes mellitus (T2DM). Gastroparesis, a common condition associated with T2DM, is exacerbated during stress such as an impending surgery. This study sought to determine whether a relationship exists between stress levels and gastric contents in fasting patients with T2DM presenting for an elective surgical or diagnostic procedure. The quality and quantity of gastric contents and preoperative stress were evaluated using gastric ultrasonography and salivary α-amylase levels. No relationship existed between preoperative stress and gastric contents; however, glycated hemoglobin levels of 7% or greater were associated with increased gastric fluid, which was the most significant finding in this study. In addition, there was a significant difference between the mean gastric volume in healthy individuals and patients with T2DM. Performance of gastric ultrasonography preoperatively provides objective data that could influence the anesthetic plan and decrease the risk of pulmonary aspiration in patients with T2DM.