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Updated: Sep 3, 2025
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 Fluid Volume in Children Scheduled for Elective Surgery After Clear Fluid Fasting
Khaled Abdelfattah Sarhan1, Hossam Hasaneen, Ahmed Hasanin
1From the Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Insights
A 1-hour fasting period for children before surgery resulted in double the gastric fluid volume (GFV) compared to a 2-hour fast. This highlights the need to balance liberal preoperative fasting with aspiration risk.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Medical Imaging
Background:
- Preoperative fasting guidelines aim to minimize the risk of pulmonary aspiration in children undergoing surgery.
- Current guidelines often recommend a 2-hour fasting period after clear fluid ingestion for pediatric patients.
- Ultrasound is a non-invasive tool used to assess gastric fluid volume (GFV).
Purpose of the Study:
- To compare the gastric fluid volume (GFV) in children after 1 hour versus 2 hours of fasting.
- To evaluate the risk of aspiration based on GFV and antral grading after different fasting durations.
Main Methods:
- A randomized, double-blinded, controlled trial involving children scheduled for elective surgery.
- Participants received 3 mL/kg of clear fluid and were randomized to 1-hour or 2-hour fasting groups.
- Gastric ultrasound was used to measure GFV, antral cross-sectional area, and assess aspiration risk.
Main Results:
- The median GFV was significantly higher in the 1-hour fasting group (0.61 mL/kg) compared to the 2-hour group (0.32 mL/kg) (P = .001).
- A higher frequency of elevated GFV (≥0.8 mL/kg) and grade 2 antral grading was observed in the 1-hour group.
- No significant difference in GFV ≥1.25 mL/kg was found between the groups.
Conclusions:
- A 1-hour fasting period after clear fluid intake in children results in a median GFV double that of a 2-hour fast.
- Findings suggest a need to reconsider the risk-benefit balance of liberal preoperative fasting protocols versus aspiration risk.
- Ultrasound assessment of GFV provides valuable data for optimizing pediatric preoperative fasting guidelines.
Background:
This study aimed to compare the gastric fluid volume (GFV) in children who fasted 1 versus 2 hours using ultrasound, after ingestion of a defined volume of clear fluid.
Methods:
Children scheduled for elective surgery were enrolled in this randomized, double-blinded, controlled trial. After receiving 3 mL kg -1 clear fluid, participants were randomized to have a gastric ultrasound after fasting for either 1 hour (1-hour group, n = 116) or 2 hours (2-hour group, n = 111). Our primary outcome was the GFV. Other outcomes included the antral cross-sectional area, frequency of high risk and low risk of aspiration, and qualitative grading for the gastric antrum.
Results:
Two hundred and twenty-seven children were available for final analysis. The median (Q1-Q3) GFV was higher in the 1-hour group versus the 2-hour group (0.61 [0.41-0.9] mL kg -1 vs 0.32 [0.23-0.47] mL kg -1 ; P value = .001). None of the study groups had GFV ≥1.5 mL kg -1 . The frequency (%) of GFV ≥1.25 mL kg -1 was comparable between both groups (2 [1.7%] vs 0 [0%], P value = .165). However, the frequency of GFV ≥0.8 mL kg -1 was higher in 1-hour group than in 2-hour group (34.5% vs 4.5%), and grade 2 antral grading score was 56.9% in 1-hour group vs 0.9% in 2-hour group ( P value <.001).
Conclusions:
In healthy children scheduled for elective surgery receiving 3 mL kg -1 clear fluid, the median GFV after 1-hour fasting was double the volume after conventional 2-hour fasting. These findings should be considered whether weighting the risk/benefit of a liberal approach to preoperative fasting versus the risk of pulmonary aspiration.
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