Preoperative clear fluid fasting and endoscopy-measured gastric fluid volume in children. 2023

Gabriella Aschkenasy, and Oren Leder, and Rivka Pardes, and Eshel A Nir, and Eyal Shteyer, and Esther Orlanski-Meyer, and Dan Turner, and Yaacov Gozal
Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel.

In light of new recommendations to shorten clear fluid fasting time before anesthesia, our study aimed at exploring residual fluid volume in the stomach after different fasting times. We intended to perform direct endoscopic aspiration of stomach contents under vision, as part of routine gastroscopy assessment. Hereby we would be able to quantify true residual gastric fluid volume and acidity in children and measure their correlation with fasting times. The study was performed as a single-center, prospective study in pediatric perioperative day care at a university-affiliated tertiary care center. Aspiration of gastric fluid contents was performed in anesthetized children aged 1-18 years undergoing an elective gastroscopy. Recorded data included patient fast time, last meal content, last clear fluid content, and aspirated gastric volume and pH, as well as patient characteristics. We included 253 gastroscopies, performed in 245 children. Mean fasting time for clear fluids was 6.9 h (range 1 h 40 min - 18 h 35 min) (SD 4.5). Mean age was 9.8 years (SD 5.1) and mean body weight was 33.2 kg (SD 18.7). Mean residual gastric volume was 12 mL (0-90) (SD 13.5) or 0.34 mL/kg (SD 0.37) and mean pH was 1.5 (SD 0.9). No significant correlation was observed between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight (r = -.103, p = .1), nor between clear fluid fasting time and the pH of the residual gastric fluid (r = -.07, p = .3). In more than half of the patients the residual gastric volume was less than 10 mL, unrelated to fasting time. In children undergoing gastroscopy, we could not demonstrate any association between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight. Since we did not see a clinically relevant association between clear fluids fasting time and gastric residual volume, this study may support the recommendation to shorten clear fluids fasting time.

UI MeSH Term Description Entries
D011300 Preoperative Care Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed) Care, Preoperative,Preoperative Procedure,Preoperative Procedures,Procedure, Preoperative,Procedures, Preoperative
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D001835 Body Weight The mass or quantity of heaviness of an individual. It is expressed by units of pounds or kilograms. Body Weights,Weight, Body,Weights, Body
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D005215 Fasting Abstaining from FOOD. Hunger Strike,Hunger Strikes,Strike, Hunger,Strikes, Hunger
D005766 Gastrointestinal Contents The contents included in all or any segment of the GASTROINTESTINAL TRACT. Digestive Tract Contents,Intestinal Contents,Stomach Contents,GI Contents,Digestive Tract Content,GI Content,Gastrointestinal Content,Intestinal Content,Stomach Content
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013270 Stomach An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the ESOPHAGUS and the beginning of the DUODENUM. Stomachs
D016099 Endoscopy, Gastrointestinal Endoscopic examination, therapy or surgery of the gastrointestinal tract. Endoscopic Gastrointestinal Surgical Procedures,Surgical Procedures, Endoscopic Gastrointestinal,Endoscopic Gastrointestinal Surgery,Gastrointestinal Endoscopic Surgical Procedures,Procedure, Endoscopic Gastrointestinal, Surgical,Procedure, Gastrointestinal Endoscopic Surgical,Procedures, Endoscopic Gastrointestinal, Surgical,Procedures, Gastrointestinal Endoscopic Surgical,Surgical Procedure, Endoscopic Gastrointestinal,Endoscopic Gastrointestinal Surgeries,Endoscopies, Gastrointestinal,Gastrointestinal Endoscopies,Gastrointestinal Endoscopy,Gastrointestinal Surgeries, Endoscopic,Gastrointestinal Surgery, Endoscopic,Surgeries, Endoscopic Gastrointestinal,Surgery, Endoscopic Gastrointestinal

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