Evaluation of Gastric Contents and Volume After Ingestion of Apple Juice versus Pure Complex Carbohydrate Using Gastric Ultrasonography: A Randomised Clinical Study

Abstract

Introduction: Gastric ultrasound is a non-invasive tool for assessing gastric content and volume. Aspiration of gastric contents is a serious perioperative complication that contributes to mortality and morbidity following general anaesthesia. The Enhanced Recovery After Surgery (ERAS) protocol and Indian Society of Anaesthesiology (ISA) fasting guidelines recommend consuming a carbohydrate drink two hours before surgery in adults. However, evidence supporting this recommendation, particularly regarding volume, is still limited and variable. Aim: To examine Gastric Residual Volume (GRV) using Ultrasonography (USG) six hours after a light breakfast and compare it with GRV two hours after consuming clear liquids. Materials and Methods: A randomised clinical study was conducted involving 100 patients who were assigned randomly to two groups: Group-C (Oral Carbohydrate, CHO) and Group-A (Apple juice), with 50 patients in each group; each patient underwent gastric USG twice: once within the first six hours after a light breakfast and again two hours after consuming 400 mL of clear liquid. USG was performed with the patient in a supine position and a Right Lateral Decubitus (RLD) position, and GRV was estimated by measuring the Antral Cross-sectional Area (ACSA) using a mathematical model. The final reading was taken from the RLD position, and qualitative analysis of the antrum was conducted using the Perlas grading system. A GRV of <1.5 mL/kg is considered low risk for aspiration. Statistical tests such as Chi-square, paired t-test, and one-way Analysis of Variance (ANOVA) were applied. Results: A total of 100 patients were analysed in the present study. The mean age was 41.04 years and 39.94 years in Group-A and Group-C, respectively. There was no significant difference in GRV between six hours after a light breakfast and two hours after clear liquid intake in either group (p>0.05). The mean GRV was 7.75 (7.23) mL and 8.01 (7.58) mL six hours after a light breakfast, and 7.71 (8.92) mL and 8.49 (9.47) mL two hours after clear liquid intake in Group-A and Group-C, respectively, among non-CKD patients. GRV was higher in CKD patients and those with an increased Body Mass Index (BMI). Conclusion: The GRV remains within safe limits after consuming 400 mL of clear liquid two hours before surgery. This finding supports the recommended volume of preoperative clear liquid intake in the ERAS protocol and ISA fasting guidelines. However, careful consideration is necessary for patients with CKD and an increased BMI.