DOI

10.21007/con.dnp.2026.0141

Faculty Advisor

Margaret Harvey, PhD, ACNP-BC, FHRS

Document Type

Poster

Publication Date

Spring 4-30-2026

Disciplines

Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Quality Improvement

Abstract

Purpose/Background

Patients with diabetes mellitus are significantly more prone to delayed gastric emptying, which can increase their risk for aspiration events in the operating room despite following standard fasting guidelines set by the American Society of Anesthesiologists (ASA). Using point-of-care gastric ultrasound, trained providers can quickly and accurately evaluate gastric volumes and risk-stratify patients based on these findings. However, these methods have not been clearly assessed in the diabetic population. The purpose of this scoping review is to map the existing evidence on the use of gastric ultrasound findings among adult patients with diabetes undergoing anesthesia.

Methods

A scoping review was conducted in accordance with PRISMA-ScR guidelines. MEDLINE, CINAHL, Embase, and Cochrane Library databases were searched from project inception through March 2025. Inclusion criteria were adult surgical patients with diabetes mellitus, preoperative gastric ultrasound, and reported fasting times. Of 612 identified records, 487 remained after duplicates were removed. After full-text review and title/abstract screening, 18 studies met the inclusion criteria. These 18 studies were classified as 12 prospective observational studies, four randomized controlled trials, and two retrospective cohort studies. A total of 1,146 patients were included.

Results

Across all studies, 28.4% (326/1,146) of diabetic patients met ASA fasting guidelines and demonstrated a “full stomach” on gastric ultrasound. Compared with non-diabetic controls, diabetic patients had significantly higher rates of increased gastric volume (odds ratio 2.31, 95% CI 1.74-3.07; p< 0.001). Mean gastric volumes in diabetic patients ranged from 1.6 to 2.4 mL/kg, exceeding the cited aspiration risk threshold of 15 mL/kg. After identification of high-risk patients, anesthetic plans were altered in 21-48% of cases, either through delaying surgery or modified airway strategies.

Implications for Nursing Practice

Evidence from this scoping review suggests that ASA fasting guidelines are insufficient in completely reducing aspiration risk in patients with diabetes. Preoperative gastric ultrasound can identify increased gastric volume in these patients, enabling appropriate adjustments to their anesthetic plan.

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