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Safe pre-operative fasting times after milk or clear fluid in children. A preliminary study using real-time
A K Sethi1, C Chatterji, S K Bhargava
1Department of Anaesthesiology, University College of Medical Sciences & GTB Hospital, Delhi, India.
Insights
Gastric emptying studies in children show that 17.5% glucose clears the stomach in 2 hours, while 3% fat milk clears in 3 hours, making them safe pre-anesthesia feeds. Further research is needed for breast milk guidelines.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Medical Imaging
Background:
- Pre-operative fasting guidelines are crucial for pediatric anesthesia safety.
- Understanding gastric emptying times for various liquids is essential to minimize aspiration risk.
Purpose of the Study:
- To evaluate and compare the gastric emptying times of different liquids in young children.
- To determine safe pre-anesthesia fasting intervals for glucose, low-fat milk, and breast milk.
Main Methods:
- Real-time ultrasonography was used to measure gastric residual volume and pH in children aged ≤5 years.
- Gastric emptying was assessed for orange-flavoured glucose, low-fat milk, and breast milk.
- A control group underwent fasting to establish baseline gastric conditions.
Main Results:
- Mean gastric emptying times were 1.53h for glucose, 2.32h for low-fat milk, and 2.43h for breast milk.
- No children receiving glucose or low-fat milk were 'at risk' at 2h and 3h, respectively.
- 13.3% of children receiving breast milk and 33.3% in the fasting group were 'at risk' at 3h.
Conclusions:
- 17.5% glucose and 3% fat milk are safe pre-anesthesia feeds, with recommended fasting intervals of 2h and 3h, respectively.
- Current evidence is insufficient to establish definitive pre-anesthesia guidelines for breast milk.
- Further real-time ultrasonography studies are needed to establish safe pre-operative feeding protocols for breast milk.
Abstract:
Gastric emptying of orange-flavoured glucose (group I), low-fat milk (group II) and breast milk (group III) was evaluated in 45 ASA grade I children of < or = 5 years of age by using real-time ultrasonography and residual gastric volume and pH was then measured. In 15 more children, residual gastric volume and pH was measured after a midnight fast (group IV). Mean (SD) gastric emptying time in group I was 1.53 (0.25) h (range 1.00-1.75), group II 2.32 (0.31) h (range 1.75-2.75) and group III 2.43 (0.27) h (range 2.00-2.75). According to Robert and Shirley's criteria, no children of group I and II were found to be 'at risk' at 2 h and 3 h, respectively, but 13.3% of group III children were labelled as 'at risk' at 3 h. The incidence of 'at risk' children in group IV was 33.3%. It was concluded that 3% fat milk or 17.5% glucose in a volume of 10 ml.kg-1 (maximum volume of 100 ml) can be given in children safely 3 h and 2 h, respectively, before anaesthesia. More real-time studies are required on breast milk to establish guidelines for its potential use as a pre-operative feed 3 h before anaesthesia.