Gastric Volume In Children Research Articles

Preoperative gastric volume assessment using ultrasound in cerebral palsy pediatric patients: a prospective observational study

BackgroundAlthough cerebral palsy is a risk factor for aspiration, there is insufficient research on residual gastric volume after preoperative fasting in children with cerebral palsy. We evaluated the incidence of a full stomach by ultrasound assessment of the gastric volume in children with cerebral palsy who underwent orthopedic surgery after preoperative fasting. MethodsThe patients fasted for 8 h for solid foods and 2 h for clear liquids. We obtained the gastric antral cross-sectional area using ultrasound in the semi-recumbent and right lateral decubitus positions. A calculated stomach volume > 1.5 mL.kg−1 was considered as full, which poses a high aspiration risk. The primary outcome was the incidence of full stomach, and the secondary outcomes were the qualitative gastric volume, correlation of disease severity categorized according to the Gross Motor Function Classification System with the residual gastric volume, gastric volume per body weight, and qualitative gastric volume. ResultsThirty-seven pediatric patients with cerebral palsy, scheduled for elective orthopedic surgery, were included for analysis. Full-stomach status was observed in none, and the gastric volume per body weight was 0.5 (0.4–0.7) mL.kg−1. No significant differences were observed in the residual gastric volume (p = 0.114), gastric volume per body weight (p = 0.117), or qualitative grade of gastric volume (p = 0.642) in relation to disease severities. ConclusionChildren with cerebral palsy who fasted preoperatively had empty or nearly empty stomachs. Further studies are required to determine the optimal fasting duration for such children.

Ultrasound assessment of gastric emptying time after a standardised light breakfast in healthy children: A prospective observational study.

Current guidelines recommend 6 h of fasting for solids before anaesthesia. However, prolonged fasting may lead to discomfort, hunger, thirst, misbehaviour and lipolysis. To prevent this, a more liberal fasting regimen has been empirically implemented in our children's hospital, allowing a shorter fasting time of 4 h for a standardised light breakfast. The aim of this study was to determine the gastric emptying time after a standardised light breakfast in healthy children. A prospective observational noninterventional study. After fasting overnight, the children had a standardised light breakfast. Before and afterwards, ultrasound examinations of the gastric antrum were performed hourly to determine the gastric antral area (GAA), which is a surrogate parameter for gastric volume in children in the right lateral position (RLP). Demographic data and fasting times are presented as mean ± SD (range) and GAA as median (interquartile range). Twenty-two children aged 7.8 (2.5 to 13.6) years volunteered for this study. After fasting overnight [735 ± 120 (467 to 930) min], the initial GAA was 3.06 (2.35 to 4.03) cm in RLP. After the light breakfast, GAA in RLP initially increased and decreased subsequently. After 4 h, GAA in RLP was lower than the initial value (median of differences -0.54, 95% confidence interval -1.00 to -0.07, P < 0.05). Correlation between GAA in RLP and fasting time was significant (r = -0.62, P < 0.0001). Using a linear regression model, the calculated mean gastric emptying time after the standardised light breakfast was 211 min for GAA = 3.06 cm. The study showed a mean gastric emptying time of less than 4 h after a standardised light breakfast in children. These results encourage our current clinical practice and support the efforts towards a more liberal fasting regimen for light meals in paediatric anaesthesia. German Registry of Clinical Studies (DRKS-ID: DRKS 00013893).

Ultrasound assessment of gastric volume in children after drinking carbohydrate-containing fluids

BackgroundGastric ultrasound is a valid tool for non-invasive assessment of the nature and volume of gastric contents in adults and children. Perioperative fasting guidelines recommend oral carbohydrates up to 2 h before elective surgery. We evaluated gastric volume in children using ultrasound before and after drinking carbohydrate fluids before surgery. MethodsPaediatric patients younger than 18 yr old undergoing elective surgery were enrolled. Initial ultrasound assessment of gastric volume was performed after fasting for 8 h. Two hours before surgery, patients were given carbohydrate drinks: 15 ml kg−1 for patients younger than 3 yr old and 10 ml kg−1 for those more than 3 yr old. Before induction of general anaesthesia, the gastric volume was reassessed. Parental satisfaction scores (0+totally satisfied, 10+totally dissatisfied) and complications were recorded. ResultsOf the 86 enrolled patients, 79 completed the study; three refused to ingest the requested volume, and surgery was delayed for more than 2 h in four patients. The mean (sd) of the initial and second ultrasound measurements were 2.09 (0.97) and 1.85 (0.94) cm2, respectively (P+0.01; mean difference 0.24 cm2, 95% confidence interval 0.06–0.43). The median (interquartile range) satisfaction score was 2.4 (0–6). Two instances of postoperative vomiting and one instance of postoperative nausea occurred. ConclusionsCarbohydrate fluids ingested 2 h before surgery reduced the gastric volume and did not cause serious complications in paediatric patients. Parents were satisfied with the preoperative carbohydrate drink. Children may benefit from drinking carbohydrate fluids up to 2 h before elective surgery. Clinical trial registrationcris.nih.go.kr (KCT0001546).

Effect of pre-operative oral ranitidine on gastric pH and volume in children.

Fifty healthy children between the age group of 8 months to 11 years were divided into two groups of 25 each. Group A acted as control, while in group B oral ranitidine 2 mg/ kg was given one hour prior to induction of anaesthesia. The incidence of gastric pH more than 2.5 was significantly higher in ranitidine group as compared to control patients (p<0.001). The mean volume of gastric aspirate in patients treated with ranitidine was 2.76±0.76 ml which was significantly lower than control group (p<0.001). It is concluded that oral ranitidine given prior to induction of anaesthesia ensures an increase in gastric pH above 2.5 and significantly reduces gastric volume in children.