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Updated: Jun 20, 2025
Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
Preoperative gastric volume assessment using ultrasound in cerebral palsy pediatric patients: a prospective
Jiwon Han1, Hyo-Seok Na2, Seihee Min1
1Chung-Ang University College of Medicine, Department of Anesthesiology and Pain Medicine, Seoul, Republic of Korea.
Insights
Children with cerebral palsy (CP) undergoing surgery had empty stomachs after standard preoperative fasting. This study found no full stomachs, suggesting current fasting guidelines may be appropriate for pediatric CP patients at risk of aspiration.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Neurology
Background:
- Cerebral palsy (CP) increases aspiration risk during anesthesia.
- Optimal preoperative fasting guidelines for children with CP are not well-established.
- Gastric residual volume assessment is crucial for identifying aspiration risk.
Purpose of the Study:
- To evaluate the incidence of a full stomach in pediatric patients with cerebral palsy after preoperative fasting.
- To assess gastric volume using ultrasound in children with CP undergoing orthopedic surgery.
- To investigate the correlation between CP severity and gastric residual volume.
Main Methods:
- Ultrasound assessment of gastric antral cross-sectional area in semi-recumbent and right lateral decubitus positions.
- Preoperative fasting protocol: 8 hours for solids, 2 hours for clear liquids.
- Definition of a full stomach: calculated stomach volume > 1.5 mL/kg, indicating high aspiration risk.
Main Results:
- No patients (0/37) exhibited a full stomach status post-fasting.
- Mean gastric volume per body weight was 0.5 mL/kg (IQR 0.4-0.7).
- No significant correlation was found between CP severity (Gross Motor Function Classification System) and residual gastric volume.
Conclusions:
- Pediatric patients with cerebral palsy had empty or near-empty stomachs after standard preoperative fasting.
- Current fasting durations appear safe regarding gastric volume in this population.
- Further research is needed to confirm optimal fasting protocols for children with CP.
Background:
Although cerebral palsy is a risk factor for aspiration, there is insufficient research on residual gastric volume after preoperative fasting in children with cerebral palsy. We evaluated the incidence of a full stomach by ultrasound assessment of the gastric volume in children with cerebral palsy who underwent orthopedic surgery after preoperative fasting.
Methods:
The patients fasted for 8 h for solid foods and 2 h for clear liquids. We obtained the gastric antral cross-sectional area using ultrasound in the semi-recumbent and right lateral decubitus positions. A calculated stomach volume > 1.5 mL.kg-1 was considered as full, which poses a high aspiration risk. The primary outcome was the incidence of full stomach, and the secondary outcomes were the qualitative gastric volume, correlation of disease severity categorized according to the Gross Motor Function Classification System with the residual gastric volume, gastric volume per body weight, and qualitative gastric volume.
Results:
Thirty-seven pediatric patients with cerebral palsy, scheduled for elective orthopedic surgery, were included for analysis. Full-stomach status was observed in none, and the gastric volume per body weight was 0.5 (0.4-0.7) mL.kg-1. No significant differences were observed in the residual gastric volume (p = 0.114), gastric volume per body weight (p = 0.117), or qualitative grade of gastric volume (p = 0.642) in relation to disease severities.
Conclusion:
Children with cerebral palsy who fasted preoperatively had empty or nearly empty stomachs. Further studies are required to determine the optimal fasting duration for such children.
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