Gastric emptying for liquids of different compositions in children

Du, Trung; Hill, Lee; Ding, Lieming; Towbin, Alexander J.; DeJonckheere, Melissa; Bennett, Paul; Hagerman, Nancy S.; Varughese, Anna M.; Pratap, Jayant Nick

doi:10.1093/bja/aex340

Cited by 35 publications

(33 citation statements)

References 31 publications

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“…These two drinks belong to clear fluid but differ in total amount of calories, osmolality, and compositional electrolyte. Previous studies have reported that gastric emptying of clear fluids was mainly dependent on the total amount of calories rather than the volume and type of fluid 24,25 . For example, a slower gastric emptying rate was observed for 500 mL of beverages than that for same volume of other fluids containing higher calories 26 .…”

Section: Discussionmentioning

confidence: 95%

Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate‐rich drink in young children: A randomized crossover study

Zhang

Zeng

et al. 2020

Pediatric Anesthesia

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Background A recent consensus statement in Europe has suggested that the fasting time for clear liquid in children can be shortened to 1 hour before a surgery. However, the study to show that 1‐hour fasting time for clear fluids is safe in young children is still lacking. This study aimed to investigate the gastric emptying time for carbohydrate‐rich drink and regular 5% glucose solution in children aged 3‐7 years. Methods After overnight fasting, individuals were randomly assigned to ingest 5 mL kg−1 of either carbohydrate‐rich drink or 5% glucose solution. One week later, the same subjects were asked to ingest the other one. Ultrasonography was performed to examine the gastric contents. Gastric antral cross‐sectional area was measured, and the gastric fluid volume was calculated before and after fluid ingestion within 120 minutes. The primary outcome was the gastric emptying time for both the clear fluids calculated using the antral cross‐sectional area and logarithms of gastric fluid volume. The degrees of thirst and hunger of two drinks were evaluated using a visual analogue scale as the secondary outcomes. Results Data from 16 individuals were analyzed. In the glucose solution group, the antral cross‐sectional area and logarithms of gastric fluid volume returned to baseline at 30 minutes after ingestion. However, in the carbohydrate‐rich drink group, the median [interquartile range; range] antral cross‐sectional area (3.69 [2.64‐5.15; 1.83‐8.93] cm2 vs 2.41 [2.10‐2.96; 1.81‐4.37] cm2, P < .001) and mean (95% confidence interval) logarithms of gastric fluid volume (2.54 [2.30‐2.79] mL vs 2.12 [1.94‐2.30] mL, P = .048) were still higher than at 60 minutes and returned to the baseline values at 90 minutes after ingestion, respectively. The degree of thirst was lower in the glucose solution group than that in the carbohydrate‐rich drink group. Conclusions Gastric emptying of carbohydrate‐rich drink is slower than that of 5% glucose solution but the residual gastric fluid volume is low one hour after ingestion of 5 mL kg−1 of either fluid.

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Section: Discussionmentioning

confidence: 95%

Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate‐rich drink in young children: A randomized crossover study

Zhang

Zeng

et al. 2020

Pediatric Anesthesia

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“…Fourth, because studies have shown little difference in gastric emptying across various types of liquids, we did not analyze the type of liquid administered to our patients before the non per os period. 34 Fifth, although we identified and excluded vital sign artifacts, artifacts could have remained that impacted our findings. 35 Sixth, we were unable to assess clinicians' awareness of fluid fasting time at the time of anesthesia induction and thus did not include it in our analysis as a potential confounder.…”

Section: Perioperative Medicinementioning

confidence: 99%

Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children

Simpao

Nelson

et al. 2020

Anesthesiology

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Background Children are required to fast before elective general anesthesia. This study hypothesized that prolonged fasting causes volume depletion that manifests as low blood pressure. This study aimed to assess the association between fluid fasting duration and postinduction low blood pressure. Methods A retrospective cohort study was performed of 15,543 anesthetized children without preinduction venous access who underwent elective surgery from 2016 to 2017 at Children’s Hospital of Philadelphia. Low blood pressure was defined as systolic blood pressure lower than 2 standard deviations below the mean (approximately the 2.5th percentile) for sex- and age-specific reference values. Two epochs were assessed: epoch 1 was from induction to completion of anesthesia preparation, and epoch 2 was during surgical preparation. Results In epoch 1, the incidence of low systolic blood pressure was 5.2% (697 of 13,497), and no association was observed with the fluid fasting time groups: less than 4 h (4.6%, 141 of 3,081), 4 to 8 h (6.0%, 219 of 3,652), 8 to 12 h (4.9%, 124 of 2,526), and more than 12 h (5.0%, 213 of 4,238). In epoch 2, the incidence of low systolic blood pressure was 6.9% (889 of 12,917) and varied across the fasting groups: less than 4 h (5.6%, 162 of 2,918), 4 to 8 h (8.1%, 285 of 3,531), 8 to 12 h (5.9%, 143 of 2,423), and more than 12 h (7.4%, 299 of 4,045); after adjusting for confounders, fasting 4 to 8 h (adjusted odds ratio, 1.33; 95% CI, 1.07 to 1.64; P = 0.009) and greater than 12 h (adjusted odds ratio, 1.28; 95% CI, 1.04 to 1.57; P = 0.018) were associated with significantly higher odds of low systolic blood pressure compared with the group who fasted less than 4 h, whereas the increased odds of low systolic blood pressure associated with fasting 8 to 12 h (adjusted odds ratio, 1.11; 95% CI, 0.87 to 1.42; P = 0.391) was nonsignificant. Conclusions Longer durations of clear fluid fasting in anesthetized children were associated with increased risk of postinduction low blood pressure during surgical preparation, although this association appeared nonlinear. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…A light breakfast of solids 4 hours prior to surgery has been advocated by some centres and has been reported to empty from the stomach within 4 hours in most children . Schmitz et al used MRI to examine residual GCV four and 6 hours after a light breakfast and found no difference in GCV.…”

Section: Discussionmentioning

confidence: 99%

“…The emptying rate of solids and nonhuman milk depends both on the caloric density and the amount of food ingested . Departments that consider introducing a light breakfast prior to surgery should arguably include a clear description of what kind of food is allowed, as well as both a time limit and a caloric limit .…”

Section: Discussionmentioning

confidence: 99%

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

Andersson

Frykholm

2019

Pediatric Anesthesia

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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.

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Gastric emptying for liquids of different compositions in children

Abstract: clinicaltrials.gov NCT02938065 clinicaltrials.gov/ct2/show/NCT02938065.

Cited by 35 publications

References 31 publications

Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate‐rich drink in young children: A randomized crossover study

Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate‐rich drink in young children: A randomized crossover study

Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children

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

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