Observational studyBMC anesthesiology2026
Preoperative gastric ultrasound reveals increased aspiration risk in diabetic patients undergoing elective intracranial tumor surgery: a prospective observational study.
Observational study in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStandard preoperative fasting guidelines are widely used to reduce the risk of pulmonary aspiration; however, their reliability in high-risk populations remains uncertain. Diabetes mellitus (DM) is associated with delayed gastric emptying, and neurological conditions such as intracranial tumors may further impair gastric motility. This study aimed to evaluate preoperative gastric antral dimensions and aspiration risk via gastric point-of-care ultrasound (POCUS) in diabetic patients undergoing elective intracranial tumor surgery.
methodsThis prospective, observational, single-center study included 48 adult patients scheduled for elective intracranial tumor surgery, comprising 24 patients with DM, and 24 non-DM patients. Preoperative gastric ultrasound was performed immediately before anesthesia induction by an anesthesiologist blinded to patient group allocation. The gastric antral cross-sectional area (CSA) and qualitative Perlas grade were assessed. The primary outcome was gastric antral CSA; secondary outcomes included estimated gastric residual volume (GRV) and the incidence of high-risk gastric ultrasound findings (Perlas Grade 2).
resultsBaseline demographic and perioperative characteristics were comparable between the groups. The median gastric antral CSA was significantly greater in the DM group than in the non-DM group (4.41 [3.73–5.53] vs. 3.80 [3.50–4.56] cm²; p = 0.021). The estimated GRV was numerically greater in the DM group but did not differ significantly between groups (p = 0.217). Although not statistically significant, Perlas Grade 2 findings were numerically more frequent in diabetic patients.
conclusionsDiabetic patients who undergo elective intracranial tumor surgery exhibit increased gastric antral dimensions and numerically higher incidence of high-risk gastric ultrasound findings despite adherence to standard fasting guidelines. These results suggest that fasting duration alone may be insufficient to exclude aspiration risk in this population. Gastric POCUS may provide valuable individualized information to guide perioperative anesthetic management in diabetic neurosurgical patients.
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