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Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
Ultrasound assessment of gastric volume in children after drinking carbohydrate-containing fluids
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea.
Insights
Preoperative carbohydrate drinks for children undergoing elective surgery significantly reduced gastric volume. This practice is safe, well-tolerated, and parents reported high satisfaction, suggesting benefits for pediatric surgical patients.
Area of Science:
- Pediatric Anesthesiology
- Gastrointestinal Physiology
- Medical Imaging
Background:
- Perioperative fasting guidelines often recommend oral carbohydrate intake up to 2 hours before elective surgery.
- Gastric ultrasound is a non-invasive method for assessing gastric content volume in pediatric patients.
- Evaluating gastric volume changes after carbohydrate fluid ingestion in children is crucial for optimizing preoperative protocols.
Purpose of the Study:
- To assess the effect of preoperative carbohydrate fluid ingestion on gastric volume in pediatric patients using ultrasound.
- To evaluate the safety and parental satisfaction associated with this preoperative feeding strategy.
Main Methods:
- Paediatric patients (<18 years) undergoing elective surgery were enrolled.
- Gastric volume was measured via ultrasound after 8-hour fasting and again 2 hours post-carbohydrate drink administration.
- Dosage varied by age: 15 ml/kg for <3 years, 10 ml/kg for >3 years.
Main Results:
- A statistically significant reduction in mean gastric volume was observed after carbohydrate intake (2.09 cm² to 1.85 cm²).
- The majority of parents reported high satisfaction with the carbohydrate drink (median score 2.4).
- Minor complications included two instances of postoperative vomiting and one of nausea.
Conclusions:
- Ingesting carbohydrate fluids 2 hours before elective surgery effectively reduces gastric volume in pediatric patients.
- This practice is associated with high parental satisfaction and a low incidence of serious complications.
- Children may benefit from preoperative carbohydrate fluid intake prior to elective surgery.
Background:
Gastric 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.
Methods:
Paediatric 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.
Results:
Of 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) cm(2), respectively (P=0.01; mean difference 0.24 cm(2), 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.
Conclusions:
Carbohydrate 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 Registration:
cris.nih.go.kr (KCT0001546).
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