Gastric content assessed with gastric ultrasound in paediatric patients prescribed a light breakfast prior to general anaesthesia: A prospective observational study

Abstract

Background A light breakfast has been found to empty from the stomach within 4 hours in healthy volunteers. Aim The aim of this study was to investigate whether a light breakfast of yoghurt or gruel empties from the stomach within 4 hours, in children scheduled for general anaesthesia. Method In this observational cohort study, children aged 1‐6 years scheduled for elective general anaesthesia were prescribed free intake of yoghurt or gruel 4 hours prior to induction. They were subsequently examined with gastric ultrasound within 4 hours of ingestion. In case of gastric contents, the gastric antral area was measured, and gastric content volume (GCV) was calculated. Results Twenty children were included in the study and the ingested amount of gruel or yoghurt ranged 2.5‐25 mL kg−1. In 15 cases, the stomach was empty with juxtaposed walls and no further measurements were made. In four cases, there was fluid present in the stomach, but the calculated gastric contents were <0.5 mL kg−1. One patient had solids in the stomach, and GCV in this patient was calculated to 2.1 mL kg−1. The patient with solids present had ingested 25 mL kg−1 of gruel 4 hours prior to assessment. The planned procedure was therefore delayed 1 hour. There were no cases of pulmonary aspiration or vomiting. Conclusion A light breakfast 4 hours prior to induction may be considered, but there is need for further studies on safe limits for the volume ingested.

Impact of clear fluid fasting on pulmonary aspiration in children undergoing general anesthesia: Results of the German prospective multicenter observational (NiKs) study

“…In this study, no cases of pulmonary aspiration of solids or milk were reported, but unfortunately the sample size of the cohort with fasting times for light meals shorter than 6 hours on the day of operation was too small for a subgroup analysis. Studies using magnetic resonance imaging or ultrasonography have shown mean gastric emptying times lower than 4 hours after a light meal in children, 11‐13 whereas in one study one case with a residual gastric content 4 hours after ingestion of a high volume of gruel (25 mL/kg) was reported 14 . Light breakfasts (eg, buttered toast with jam, cereal flakes with milk or yoghurt) are well established at many centers for children scheduled for a late timeslot on the operation schedule, but a better definition of light meals regarding volume and composition and safety studies with a large sample size is still needed.…”

Fasting in pediatric anesthesia: the art of making simple things complex

“…Data extraction was based on 15 studies (Table 1, Ref. [2,[7][8][9][10][11][12][13][14][15][16][17][18][19]). These include studies on children ranging in age from preterm neonates at 28 weeks gestation to 18 years.…”

“…These guidelines, however, cannot replace assessment of individual pulmonary aspiration risk. Regard-less of fasting times, some patients will remain at high risk of regurgitation and pulmonary aspiration of gastric content in relation to anesthesia since various factors influence gastric emptying and intestinal motility [21][22][23][24]. Firstly, mechanical obstruction due to pathologies (e.g., pyloric stenosis, malrotation with volvulus, intestinal atresia or stenosis) cause retention of intestinal content [25].…”

“…Liquid volume of <0.5 mL/kg was present in four children. One child had solid gastric content after ingesting twice the volume of the other children [13]. Three studies investigated the mean gastric emptying (GE) time in healthy children.…”

Asleep or awake: is paediatric regional anaesthesia without general anaesthesia possible?

“…Paediatric anaesthetists in Uppsala, Sweden have been drivers in this development, even questioning fasting times for semisolids and solids. 13 Thus, children having 'awake' regional anaesthesia may be a group where even more liberal fasting rules may be appropriate. If use of the Viennese concept makes it possible to reduce the traditional waiting times for fasting, it could perhaps result in more effective use of limited hospital resources.…”