Gastric Volume in Diabetic Patients Undergoing Staged Bilateral Total Knee Arthroplasty

Seoul National University Bundang Hospital40 enrolled

Overview

Aspiration of gastric contents during perioperative period is a grave complication with significant morbidity and mortality. Diabetic patients have a higher incidence of autonomic dysfunction, causing gastropathy. They are known to have gastroparesis and the consequent delayed gastric emptying which predisposes them to an increased risk of aspiration than the general population. Furthermore, other common factors can influence the gastric emptying rate, as for example, old age, pain, and the use of opioid analgesics. In the previous study, evidence of increased pain was reported in patients undergoing staged bilateral total knee arthroplasty, in whom the second operated knee had greater sensitivity (tertiary hyperalgesia) due to the surgical injury to the first operated knee. In the present study, we will evaluate the effect of old age, diabetes, surgical stress, pain, and the use of analgesics on the residual gastric volume in elderly patients undergoing staged-bilateral total knee arthroplasty.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Degenerative Arthritis

Interventions

Ultrasonic measurement of antral areaPROCEDURE

Ultrasound exam is done before the induction of spinal anesthesia. Three consecutive measurements of the anteroposterior (AP) and cranio-caudal (CC) diameters are performed. The cross-sectional area (CSA) of antrum is shown by the following formula: CSA = AP x CC x ㅠ/4. Antral area will correspond to the average of the three measures.

Eligibility

Sex: ALLMin age: 65 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients scheduled for staged bilateral total knee arthroplasty aged 65 to 85 years * American Society of Anestheiologist physical status classification 1, 2, and 3 * Body mass index \< 35 kg/cm2 Exclusion Criteria: * Previous surgery of the upper gastrointestinal tract * Achalasia

Outcomes

Primary Outcomes

Volume of Gastric Contents

A "full stomach" is defined as on containing a) solid or thick fluid content or b) 1.5 mL/kg of clear fluid.

Time frame: Less than one hour prior to surgery

Secondary Outcomes

Numerical rating pain scale

Postoperative pain score (0 = no pain, 10 = very severe pain)

Time frame: One hour prior to surgery, Postoperative 24 and 48 hour

Rescue analgesics

Amounts of the analgesics administered to manage the postoperative pain

Time frame: Postoperative 24 and 48 hour