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Updated: Oct 26, 2025
Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
Gastric emptying time of two different quantities of clear fluids in children: A double-blinded randomized controlled
Sunny Taye1, Sadik Mohammed1, Pradeep Bhatia1
1Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, India.
Insights
Healthy children can safely drink up to 5 ml/kg of clear fluids one hour before surgery. This study found that gastric emptying time was similar for 3 ml/kg and 5 ml/kg fluid intake in children.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Surgical Risk Management
Background:
- Increased preoperative gastric volume elevates perioperative pulmonary aspiration risk in children.
- Traditional overnight fasting is being challenged by guidelines recommending 2-hour clear fluid fasting.
- Emerging evidence suggests 3 ml/kg clear fluids are safe up to 1 hour before anesthesia.
Purpose of the Study:
- To compare gastric volume and gastric emptying time after ingestion of 3 ml/kg and 5 ml/kg of clear fluids in children.
- To evaluate the safety of reduced preoperative fasting times for clear fluids.
- To assess the impact of fluid volume on gastric emptying in pediatric surgical patients.
Main Methods:
- 44 children (6-14 years) were enrolled and randomly assigned to receive either 3 ml/kg or 5 ml/kg of 5% Dextrose.
- Gastric volume was assessed using ultrasound at baseline and every 5 minutes post-ingestion until baseline volume was reached.
- Primary endpoint was gastric emptying time; secondary endpoints included antral cross-sectional area and gastric volume.
Main Results:
- Gastric emptying time and half-time were comparable between the 3 ml/kg and 5 ml/kg groups (p=0.16 and p=0.44, respectively).
- In both groups, gastric volume and antral cross-sectional area increased significantly post-ingestion and returned to baseline within 1 hour.
- Demographics, preoperative fasting duration, and baseline gastric volume were similar across both groups.
Conclusions:
- Ingesting 5 ml/kg of clear fluids resulted in gastric volume returning to baseline within 1 hour.
- Preoperative fasting time for clear fluids in healthy children can be safely reduced to 1 hour.
- Children undergoing elective procedures can be safely allowed to consume up to 5 ml/kg of clear fluids 1 hour prior to anesthesia.
Background:
Perioperative pulmonary aspiration risk increases with increased preoperative gastric volume; hence traditionally, healthy children are kept fasted overnight before surgery. Current guidelines recommend 2-h clear fluids fasting prior to anesthesia. However, emerging evidence favors allowing 3 ml/kg clear fluids up to 1-h before anesthesia. We compared the gastric volume and gastric emptying time after ingestion of 3 ml/kg and 5 ml/kg of clear fluids.
Methods:
The present study enrolled 44 children, aged between 6 and 14 years. On the day of surgery, baseline gastric volume was estimated using ultrasound and patients were randomly allocated into two groups of equal number, that is, Group 3 and Group 5 (patients received 3 ml/kg and 5 ml/kg 5% Dextrose respectively). Repeated gastric ultrasound was performed at every 5 min until the gastric volume reached baseline levels. The primary objective of the study was to compare gastric emptying time. Secondary objectives included comparison of antral cross-sectional area and gastric volume.
Results:
The demographic profile, preoperative fasting duration for clear fluids, and baseline gastric volume were comparable between groups. In both groups, compared to baseline the antral cross-sectional area and gastric volume increased significantly following fluid ingestion and then decreased exponentially to reach baseline within 1-h. The median (IQR) (range) gastric emptying time (minutes) [35.0 (28.8, 40.0) (20.0-45.0) in group 3 and 40.0 (28.8, 45.0) (20.0-50.0) in group 5] and emptying half-time (minutes) [17.0 (15.7, 21.5) (14.4-24.0) in group 3 and 18.6 (16.0, 22.0) (15.1-23.8) in group 5] were comparable [median difference -5 (95% CI -7.8 to 2.1) and -1.5 (95% CI -2.3 to 1.0), respectively] (p = .16 and p = .44, respectively).
Conclusion:
As the gastric volume returned to baseline within 1-h even after ingesting 5 ml/kg clear fluids, the preoperative fasting time can be reduced to 1-h and healthy children undergoing elective procedure can be safely allowed to drink up to 5 ml/kg clear fluids.
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