The Effect of Stress on the Residual Gastric Volume

Study Overview
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Brief Summary
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In our institution, many patients undergo staged bilateral total knee arthroplasty at weekly intervals, and most of the patients are older adults with degenerative arthritis. As recommended, the older adult patients who undergoing total knee arthroplasty drink carbohydrate-containing fluid (400 ml) 2 hours prior to surgery. In this type of surgery, there are additional points to consider when applying the fasting guidelines. This is because, in addition to the factor of advanced age, which can affect gastric emptying time, the patient's physical, medical, and psychological conditions at the first and the second operation may be different. For example, the effect of the acute pain that occurs after the first total knee arthroplasty and subsequent opioids administered on gastric motility cannot be ignored. However, to date, there have been no studies examining the association of stress (emotional and surgical) and residual gastric volume of older adult patients with staged bilateral total knee arthroplasty and whether there is a difference according to the stage when carbohydrate-containing fluid is ingested. In the present study, the investigators will evaluate the effect of emotional stress, surgical stress, pain, and the use of opioids on the residual gastric volume in older adults undergoing staged-bilateral total knee arthroplasty.

Official Title
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The Effect of Stress on the Residual Gastric Volume in Older Adults Undergoing Staged-bilateral Total Knee Arthroplasty After Drinking Carbohydrate-containing Fluids: A Prospective Observational Study

Conditions
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Arthritis Knee

Intervention / Treatment
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* Dietary Supplement: Carbohydrate drinking


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for staged bilateral total knee arthroplasty aged ≥ 65 American Society of Anesthesiologists physical status classification 1, 2, and 3 Body mass index < 35 kg/cm2 Patients administered carbohydrate-containing fluid 2 hours prior to surgery Exclusion Criteria: Previous surgery of the upper gastrointestinal tract Achalasia Diabetes

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group C<br>Patients drank carbohydrate fluid 2 hours prior to surgery. | Dietary Supplement: Carbohydrate drinking<br>* Administration of carbohydrate fluid<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Level of stress hormone 1 | Stress hormone (interleukin-1β, interleukin-6, interleukin-10, and tumor necrosis factor-α) measured after induction of spinal anesthesia | After induction of spinal anesthesia at first stage total knee arthroplasty/ an average 10 minutes | 
| Level of stress hormone 2 | Stress hormone (interleukin-1β, interleukin-6, interleukin-10, and tumor necrosis factor-α) measured after induction of spinal anesthesia | After induction of spinal anesthesia at second stage total knee arthroplasty/ an average 10 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gastric volume 1 | Gastric volume measured before induction of spinal anesthesia using ultrasound | First stage operation, during the gastric volume measuring at preoperative holding area/ an average of 30 minutes | 
| Gastric volume 2 | Gastric volume measured before induction of spinal anesthesia using ultrasound | Second stage operation, during the gastric volume measuring at preoperative holding area/ an average of 30 minutes | 
| Anxiety scale 1 | Anxiety scale measured before surgery | First stage operation, one day before surgery/ an average of 30 minutes | 
| Anxiety scale 2 | Anxiety scale measured before surgery | Second stage operation, one day before surgery/ an average of 30 minutes |