Ultrasonographic Evaluation of Residual Gastric Volume after Ginger and Maltodextrin Ingestion: a Randomized, Crossover Trial in Volunteers
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Abstract
Background: An ingestion of clear fluid up to two hours before surgery has been accepted for patients undergoing elective procedures. Preoperative 12.5% maltodextrin has been administered to enhance patient recovery without reported adverse effects, however, there is still lack of well-defined impact on gastric residual volume (GRV) of different kinds of fluid. Objectives: To evaluate GRV measured by ultrasonography two hours after consuming ginger beverage compared to maltodextrin solution in healthy volunteers. Methods: Ten healthy volunteers, after an overnight fasting, ingested 400 ml of ginger and 12.5% maltodextrin in a randomized, crossover manner with one-week interval between ingestions. The antral cross-sectional area (CSA) was measured using ultrasonographic two-dimensional technique to evaluate GRV before and 2 hours after consumption of fluids. The primary outcome was predicted stomach volume calculated by validated model using antral CSA and age as variables. Secondary outcomes were side effects observed during the study. Results: The average fasting GRV was 1.0±0.5 ml/kg. Two hours after ingestion of ginger and maltodextrin, mean GRVs were 95.4±43.8 and 112.9±49.6 ml, respectively. There was no statistically significant difference in GRVs after ingestion of ginger and maltodextrin (mean difference ± standard error = -17.5±16.0 ml; 95%CI -48.8 to 13.9; P=0.307) and no participants had adverse effects. Conclusion: In healthy adults, the residual gastric volume, evaluated by ultrasonography, at two hours after ingestion of ginger beverage was not significantly different from 12.5% maltodextrin solution ingestion.
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References
Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth. 1999;83:453-60.
Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109-17.
Agarwal A, Chari P, Singh H. Fluid deprivation before operation. The effect of a small drink. Anaesthesia. 1989;44:632-4.
Maltby JR, Sutherland AD, Sale JP, Shaffer EA. Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Anesth Analg. 1986;65:1112-6.
McGrady EM, Macdonald AG. Effect of the preoperative administration of water on gastric volume and pH. Br J Anaesth. 1988;60:803-5.
Phillips S, Hutchinson S, Davidson T. Preoperative drinking does not affect gastric contents. Br J Anaesth. 1993;70:6-9.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126:376-93.
Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg. 2001;93:1344-50.
Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update. Curr Opin Clin Nutr Metab Care. 2001;4:255-9.
Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg. 1995;222:728-34.
Mandal P, Das A, Majumdar S, Bhattacharyya T, Mitra T, Kundu R. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery. Pharmacognosy Res. 2014;6:52-7.
Bolondi L, Bortolotti M, Santi V, Calletti T, Gaiani S, Labo G. Measurement of gastric emptying time by real-time ultrasonography. Gastroenterology. 1985;89:752-9.
Perlas A, Mitsakakis N, Liu L, et al. Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesth Analg. 2013;116:357-63.
Raidoo DM, Rocke DA, Brock-Utne JG, Marszalek A, Engelbrecht HE. Critical volume for pulmonary acid aspiration: reappraisal in a primate model. Br J Anaesth. 1990;65:248-50.
Roberts RB, Shirley MA. Reducing the risk of acid aspiration during cesarean section. Anesth Analg. 1974;53:859-68.
James CF, Modell JH, Gibbs CP, Kuck EJ, Ruiz BC. Pulmonary aspiration-effects of volume and pH in the rat. Anesth Analg. 1984;63:665-8.
Read MS, Vaughan RS. Allowing pre-operative patients to drink: effects on patients’ safety and comfort of unlimited oral water until 2 hours before anaesthesia. Acta Anaesthesiol Scand. 1991;35:591-5.
Harter RL, Kelly WB, Kramer MG, Perez CE, Dzwonczyk RR. A comparison of the volume and pH of gastric contents of obese and lean surgical patients. Anesth Analg. 1998;86:147-52.
Van de Putte P, Perlas A. What is the evidence that twenty-five millilitres of gastric fluid puts patients at risk of aspiration? Anaesth Intens Care. 2017;45:127-8.
Van de Putte P, Perlas A. The link between gastric volume and aspiration risk. In search of the Holy Grail? Anaesthesia. 2018;73:274-9.
Ohashi Y, Walker JC, Zhang F, et al. Preoperative gastric residual volumes in fasted patients measured by bedside ultrasound: a prospective observational study. Anaesth Intens Care. 2018;46:608-13.
Van de Putte P, Vernieuwe L, Jerjir A, Verschueren L, Tacken M, Perlas A. When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients. Br J Anaesth. 2017;118:363-71.
Perlas A, Davis L, Khan M, Mitsakakis N, Chan VW. Gastric sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg. 2011;113:93-7.
Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113:12-22.
Maltby JR, Lewis P, Martin A, Sutheriand LR. Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery. Can J Anaesth. 1991;38:425-9.
Scarr M, Maltby JR, Jani K, Sutherland LR. Volume and acidity of residual gastric fluid after oral fluid ingestion before elective ambulatory surgery. CMAJ. 1989;141:1151-4.
Noba L, Wakefield A. Are carbohydrate drinks more effective than preoperative fasting: a systematic review of randomised controlled trials. J Clin Nurs. 2019;28:3096-116.
Gomes PC, Caporossi C, Aguilar-Nascimento JE, Silva AM, Araujo VM. Residual gastric volume evaluation with ultrasonography after ingestion of carbohydrate- or carbohydrate plus glutamine-enriched beverages: a randomized, crossover clinical trial with healthy volunteers. Arq Gastroenterol. 2017;54:33-6.
Parkman HP, Yamada G, Van Natta ML, et al. Ethnic, racial, and sex differences in etiology, symptoms, treatment, and symptom outcomes of patients with gastroparesis. Clin Gastroenterol Hepatol. 2019;17:1489-99 e8.
Phillips WT. Gastric emptying in ethnic populations possible relationship to development of diabetes and metabolic syndrome. Ethn Dis. 2006;16:682-92.
Leiper JB. Fate of ingested fluids: factors affecting gastric emptying and intestinal absorption of beverages in humans. Nutr Rev. 2015;73(Suppl 2):57-72.
Wu KL, Rayner CK, Chuah SK, et al. Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol. 2008;20:436-40.
Hu ML, Rayner CK, Wu KL, et al. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 2011;17:105-10.
Nakamura M, Uchida K, Akahane M, Watanabe Y, Ohtomo K, Yamada Y. The effects on gastric emptying and carbohydrate loading of an oral nutritional supplement and an oral rehydration solution: a crossover study with magnetic resonance imaging. Anesth Analg. 2014;118:1268-73.
Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009;111:82-9.