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Gastric contents in children presenting for upper endoscopy
D A Schwartz1, N R Connelly, C A Theroux
1Department of Anesthesiology, Baystate Medical Center Children's Hospital, Springfield, Massachusetts 01199, USA.
Insights
Children with gastrointestinal symptoms undergoing upper endoscopy do not have increased gastric fluid volume or acidity after fasting. This suggests they do not pose a higher anesthetic risk for aspiration compared to healthy children.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Aspiration Risk Assessment
Background:
- Children with gastrointestinal disorders often require sedation or anesthesia for procedures like upper endoscopy.
- Previous studies excluded these children, leaving a gap in understanding their aspiration risk.
- Accurate assessment of gastric fluid volume and pH is crucial for characterizing aspiration risk in this population.
Purpose of the Study:
- To analyze gastric fluid volume and pH in children with gastrointestinal symptoms undergoing upper endoscopy.
- To compare these findings with historical data from healthy, fasted children.
- To determine if gastrointestinal symptoms increase anesthetic aspiration risk in pediatric patients.
Main Methods:
- Prospective measurement of gastric fluid volume and pH in 248 children (2 months to 18 years) undergoing upper endoscopy.
- Standardized fasting protocols (6-8 hours) were followed for all participants.
- Gastric contents were measured endoscopically, and pH was determined using pH paper.
Main Results:
- Mean gastric fluid volume was 0.35 ± 0.45 mL/kg, with 33% exceeding 0.4 mL/kg.
- Mean gastric fluid pH was 1.37 ± 1.6, with 87% below 2.5.
- Gastric fluid volumes were highest in children presenting with abdominal pain, but overall findings were similar to historical controls.
Conclusions:
- Fasted children with gastrointestinal symptoms do not exhibit increased gastric fluid volume or acidity compared to healthy controls.
- These findings do not support the notion that children with gastrointestinal symptoms have a higher anesthetic aspiration risk.
- Standard fasting guidelines appear sufficient for managing aspiration risk in pediatric patients undergoing endoscopy, regardless of GI symptoms.
Unlabelled:
Previous studies of gastric contents in children presenting for surgery specifically excluded those with gastrointestinal disorders. Because these children often need sedation or anesthesia for procedures such as upper endoscopy, it is important to determine the gastric fluid volume and pH in this group to better characterize their risk of aspiration. We therefore analyzed the gastric fluid volume and pH of children with a variety of gastrointestinal symptoms presenting for upper endoscopy. After obtaining institutional review board approval, the stomach contents of 248 children (aged 2 mo to 18 yr) presenting for upper endoscopy were prospectively measured under direct endoscopic vision. Children were fasted for both solids and liquids for at least 6 h (<6 mo) or 8 h (>6 mo). Gastric fluid pH was measured using pH paper. Children received either deep sedation or general anesthesia and were grouped according to their presenting diagnosis. Results were analyzed by using analysis of variance, Kruskal-Wallis, and correlation (P value < 0.05). The mean gastric fluid volume was 0.35 +/- 0.45 mL/kg (range 0-3.14 mL/kg), and the mean gastric fluid pH was 1.37 +/- 1.6 (range 1-7). Of the children, 33% had gastric fluid volumes >0.4 mL/kg, 87% had gastric fluid pH <2.5, and 30% had gastric fluid volume >0.4 mL/kg and pH <2.5. Children with the presenting complaint of abdominal pain had the largest gastric fluid volumes. These data are not appreciably different from historical controls (healthy children fasted for an equivalent period of time who did not have gastrointestinal symptoms).
Implications:
When fasted for at least 6-8 h, children with a history of gastrointestinal symptoms presenting for upper endoscopy did not have gastric contents with increased volume and acidity compared with previously published groups of children without gastric symptoms who were fasted the same length of time. These results do not support the argument that children with gastrointestinal symptoms pose an increased anesthetic risk for aspiration.