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Gastric residual volume in infants and children following a 3-hour fast
B R Miller1, J A Tharp, W B Issacs
1Department of Anesthesiology, Children's Hospital, Denver, CO.
Insights
Shorter preoperative fasting intervals (3 hours) did not significantly alter gastric residual volume in pediatric patients compared to 10-hour intervals. Gastric pH remained low in both groups, indicating safety for shorter nil per os (NPO) periods.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Surgical Patient Management
Background:
- Preoperative fasting guidelines aim to minimize aspiration risk in pediatric patients.
- Current guidelines often recommend prolonged nil per os (NPO) periods, potentially causing discomfort.
- The impact of shorter fasting intervals on gastric contents in infants requires further investigation.
Purpose of the Study:
- To compare gastric residual volume and pH in pediatric patients after 3-hour versus 10-hour NPO intervals.
- To evaluate the efficacy of dye-dilution and aspiration techniques for measuring gastric residual volume.
Main Methods:
- Forty-four healthy infants (1 month to 5 years) were randomized into 3-hour or 10-hour NPO groups.
- Gastric residual volume was measured using both dye-dilution and gastric aspiration techniques.
- Gastric pH was also measured in both groups.
Main Results:
- No significant difference in gastric residual volume was found between the 3-hour and 10-hour NPO groups.
- The dye-dilution technique yielded significantly greater gastric residual volumes than aspiration in both groups.
- Mean gastric pH was consistently below 2.0 in both NPO groups.
Conclusions:
- A 3-hour preoperative fasting interval with clear liquids appears safe for pediatric patients regarding gastric volume.
- The dye-dilution method may overestimate gastric residual volume compared to aspiration.
- Shorter NPO periods may be feasible without compromising gastric safety markers in pediatric surgery.
Abstract:
The effect of a 3-hour versus a 10-hour preoperative fasting interval on the gastric residual volume and gastric pH of pediatric patients was evaluated. Forty-four healthy infants, 1 month to 5 years of age, were randomly assigned to one of two groups. The 3-hour nil per os (NPO) group consisted of 19 infants kept NPO for 3 hours following ingestion of up to 4 ounces of 5% dextrose in water (D5W). The control group consisted of 25 infants who remained NPO an average of 10 hours prior to surgery. Gastric residual volume was calculated using the dye-dilution technique. After the dye marker was injected into the stomach, complete aspiration of the stomach (including the volume of dye marker plus residual gastric contents) was attempted as another method to measure gastric residual volume. There were no significant differences in gastric residual volume between the 3-hour and the 10-hour NPO groups using either the dye-dilution or aspiration methods. However, there were significant differences between the two measuring techniques. Gastric residual volume was significantly greater in volume when measured by the dye-dilution technique than it was when measured by the aspiration technique in both the 10-hour (p less than 0.009) and the 3-hour (p less than 0.0009) NPO groups. Complete aspiration of a known volume of fluid injected through the orogastric tube was not possible in 23 of the 44 (52.4%) infants. Mean gastric pH was less than 2.0 in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)