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Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate-rich drink in young children: A
Yan-Ling Zhang1, Hui Li1, Hua Zeng1
1Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China.
Insights
Gastric emptying of a carbohydrate-rich drink is slower than 5% glucose solution in children aged 3-7 years. However, residual gastric fluid volume remains low one hour after ingesting either clear fluid, supporting shorter fasting times.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Clinical Nutrition
Background:
- European consensus suggests 1-hour fasting for clear liquids before pediatric surgery.
- Evidence supporting the safety of 1-hour fasting for clear fluids in young children is limited.
- This study addresses the need for data on gastric emptying times in this age group.
Purpose of the Study:
- To investigate and compare the gastric emptying times of a carbohydrate-rich drink and a 5% glucose solution in children aged 3-7 years.
- To assess the safety of these fluids for shorter pre-operative fasting protocols.
Main Methods:
- Children aged 3-7 years were randomly assigned to ingest either a carbohydrate-rich drink or a 5% glucose solution (5 mL/kg).
- Gastric emptying was assessed using ultrasonography to measure gastric antral cross-sectional area and calculate gastric fluid volume over 120 minutes.
- A crossover design was used, with subjects ingesting the alternative fluid one week later. Thirst and hunger were secondary outcome measures.
Main Results:
- Gastric emptying for the 5% glucose solution returned to baseline within 30 minutes.
- The carbohydrate-rich drink showed slower gastric emptying, with gastric fluid volume and antral area remaining elevated at 60 minutes and returning to baseline at 90 minutes.
- Thirst levels were lower after ingesting the glucose solution compared to the carbohydrate-rich drink.
Conclusions:
- Gastric emptying of a carbohydrate-rich drink is slower than that of a 5% glucose solution in children aged 3-7 years.
- Despite slower emptying, residual gastric fluid volume is low one hour after ingestion of either fluid.
- These findings support the potential safety of 1-hour fasting for clear liquids in pediatric patients, aligning with recent European recommendations.
Background:
A recent consensus statement in Europe has suggested that the fasting time for clear liquid in children can be shortened to 1 hour before a surgery. However, the study to show that 1-hour fasting time for clear fluids is safe in young children is still lacking. This study aimed to investigate the gastric emptying time for carbohydrate-rich drink and regular 5% glucose solution in children aged 3-7 years.
Methods:
After overnight fasting, individuals were randomly assigned to ingest 5 mL kg-1 of either carbohydrate-rich drink or 5% glucose solution. One week later, the same subjects were asked to ingest the other one. Ultrasonography was performed to examine the gastric contents. Gastric antral cross-sectional area was measured, and the gastric fluid volume was calculated before and after fluid ingestion within 120 minutes. The primary outcome was the gastric emptying time for both the clear fluids calculated using the antral cross-sectional area and logarithms of gastric fluid volume. The degrees of thirst and hunger of two drinks were evaluated using a visual analogue scale as the secondary outcomes.
Results:
Data from 16 individuals were analyzed. In the glucose solution group, the antral cross-sectional area and logarithms of gastric fluid volume returned to baseline at 30 minutes after ingestion. However, in the carbohydrate-rich drink group, the median [interquartile range; range] antral cross-sectional area (3.69 [2.64-5.15; 1.83-8.93] cm2 vs 2.41 [2.10-2.96; 1.81-4.37] cm2 , P < .001) and mean (95% confidence interval) logarithms of gastric fluid volume (2.54 [2.30-2.79] mL vs 2.12 [1.94-2.30] mL, P = .048) were still higher than at 60 minutes and returned to the baseline values at 90 minutes after ingestion, respectively. The degree of thirst was lower in the glucose solution group than that in the carbohydrate-rich drink group.
Conclusions:
Gastric emptying of carbohydrate-rich drink is slower than that of 5% glucose solution but the residual gastric fluid volume is low one hour after ingestion of 5 mL kg-1 of either fluid.
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