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Gastric aspirates after trauma in children
S R Bricker1, A McLuckie, D A Nightingale
1Royal Liverpool Children's Hospital.
Insights
Predicting a safe fasting interval before emergency surgery in children is unreliable. Gastric aspirate volumes can be significant even after prolonged fasting or delayed injury, highlighting the need for prompt airway management.
Area of Science:
- Pediatric Anesthesiology
- Trauma Surgery
- Gastrointestinal Physiology
Background:
- Pre-operative fasting guidelines aim to minimize gastric volume and reduce aspiration risk in pediatric patients.
- Trauma patients often present with unpredictable timelines regarding food intake and injury, complicating adherence to fasting protocols.
Purpose of the Study:
- To investigate the relationship between pre-operative starvation duration, time from food intake to injury, and gastric aspirate characteristics in pediatric trauma patients.
- To determine if established fasting intervals reliably predict safe gastric volumes for emergency anesthesia induction in this population.
Main Methods:
- Analysis of gastric aspirate volume and pH in 110 children (aged 1-14 years) undergoing surgery for trauma.
- Correlation of aspirate data with pre-operative starvation duration and the interval between oral intake and injury.
Main Results:
- Larger gastric aspirates were observed in children fasted for 4-6 hours compared to those fasted up to 10 hours.
- Children injured within 2 hours of eating had larger aspirates than those with longer intervals (p < 0.05).
- A significant proportion of children, even after prolonged fasting (over 8 hours) or extended post-intake injury intervals (3+ hours), had substantial gastric aspirates (>0.4 ml/kg).
Conclusions:
- A 'safe' pre-operative fasting interval cannot be reliably predicted in pediatric trauma patients.
- Prompt tracheal intubation is recommended as the safest strategy for airway management in children requiring emergency anesthesia post-trauma.
Abstract:
The volumes and pH of gastric aspirates obtained from 110 children (aged 1-14 years) who underwent surgery for trauma were related to the duration of pre-operative starvation and to the interval between food and injury. Aspirates were larger in children fasted for 4-6 hours than in those fasted for up to 10 hours, and were larger in children injured within 2 hours of eating than in those in whom this interval was longer (p less than 0.05). However, 19 of 39 children (49%) starved for over 8 hours had an aspirate of more than 0.4 ml/kg, as did five of 16 children (31%) injured 3 or more hours after eating. Thus, a 'safe' interval between oral intake and induction cannot be predicted. We conclude that securing the airway by prompt tracheal intubation is the safest way to manage any child who presents for emergency anaesthesia after trauma.