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Gastric volume and pH in children for emergency surgery
Insights
Fifty percent of pediatric surgical patients face aspiration risk due to gastric contents. Pre-anesthetic fasting significantly reduces this risk, emphasizing careful pre-operative evaluation for all emergency surgery cases.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Aspiration of gastric contents during anesthesia poses a significant risk to patients, particularly in emergency surgical settings.
- Pediatric patients undergoing emergency surgery present unique challenges regarding gastric volume and acidity.
- Understanding risk factors for pulmonary aspiration is crucial for patient safety in pediatric anesthesia.
Purpose of the Study:
- To assess the prevalence of gastric aspiration risk in children undergoing emergency surgery.
- To identify patient demographics and clinical factors associated with increased aspiration risk.
- To evaluate the impact of fasting duration on gastric content volume and pH in this population.
Main Methods:
- Prospective study involving 101 children (3 months to 15 years) admitted for emergency surgery.
- Measurement of gastric content volume and pH via aspiration prior to anesthesia.
- Analysis of risk based on defined volume and pH thresholds.
Main Results:
- 50% of the pediatric patients were identified as being at risk for pulmonary aspiration.
- Higher risk was observed in children aged 6-10 years.
- Risk varied by disease type (abdominal, urogenital, orthopedic showed similar risk; superficial lesions lower risk).
- Fasting duration significantly influenced gastric content volume.
Conclusions:
- A significant proportion of children undergoing emergency surgery are at risk of gastric aspiration.
- Pre-anesthetic fasting is a critical factor in mitigating aspiration risk.
- Comprehensive pre-anesthetic evaluation, including assessment of gastric contents, is essential for all pediatric emergency surgical cases.
Abstract:
The volume and pH of gastric contents aspirated prior to anaesthesia were measured in 101 children admitted for emergency surgery. The children were aged between 3 months and 15 years. If we define potential patients at risk by means of the volume and pH of the gastric contents, then 50.0% of the children were at risk of aspiration into the lungs. The number of patients at risk was higher in children aged between 6 and 10 years. There was almost the same risk in the groups with abdominal-, urogenital-, and orthopaedic diseases, while the number of patients at risk was less in the group with superficial lesions. The length of fasting time in the child considerably influenced the volume of gastric contents in emergency surgical cases. It is concluded that in children admitted for emergency surgery there is a risk of aspiration of gastric contents into the lungs. The risk is reduced by preanaesthetic fasting. All children admitted for emergency surgery must be carefully evaluated prior to anaesthesia with special reference to gastric aspiration.