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Gastric aspirates after trauma in children
S R Bricker1, A McLuckie, D A Nightingale
1Royal Liverpool Children's Hospital.
Anaesthesia
|September 1, 1989
Summary
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.