Gastric emptying time after clear fluid administration in cirrhotic patients undergoing endoscopic procedures under Anaesthesia: A randomised controlled trial.

Prior to procedure, a brief pre-anaesthetic evaluation will be done. Intravenous access will be secured. Patients will be randomly assigned to one of the 3 groups: the control group (>6 hours), and intervention groups of 2 h and 3 h (n = 65 each).

The intervention group will receive 250ml carbohydrate fluid (apple juice) 2 h or 3h prior to the scheduled endoscopic procedure, and control group will receive nothing.

Preoperative wellbeing will be assessed, and Gastric ultrasound will be done in supine and right lateral position. Perioperative patient wellbeing will be assessed as VAS score for- Thirst, Hunger, Headache, Nausea/ vomiting, Weakness/ fatigue and Dryness of mouth.

Gastric volume will be predicted by 3-point grading system

grade 0- empty stomach (empty antrum in both the supine and right lateral positions)

grade 1- minimal fluid < 100ml (volume detected only in the right lateral position)

grade 2 - higher fluid volumes (>100 ml) antrum distended with fluid in both supine and right lateral positions, higher risk of regurgitation of gastric contents on induction of anaesthesia

Grade 1 and 2 patients will be assessed again after 1 hr and will be taken after Grade 0. Grade 0 patients will be taken for procedure.

In the endoscopy room, standard monitoring devices will be attached. Oxygen supplementation at 4 L/min will be administered through nasal cannula. With the patients in the left lateral position, induction will be done with intravenous propofol (1.5-2 mg/kg). Endoscopy will be performed and fluid if present, will be aspirated and calculated.

Gastric fluid >/= 1.5ml/kg will be considered as high risk for bronchoaspiration. Intraprocedural Hemodynamics will be assessed at 0, 1 and 5 mins by measuring mean arterial pressure (MAP), SpO2, and HR. Patients will be assessed post procedure for any complications and patient wellbeing in terms of thirst, hunger, headache, nausea, vomiting, weakness, fatigue and dryness of mouth.