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Gastric content assessed with gastric ultrasound in paediatric patients prescribed a light breakfast prior to general anaesthesia. A prospective observational study.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
(English)In: Article in journal (Other academic) Accepted
Abstract [en]

Background:

A light breakfast has been found to empty from the stomach within four hours in healthy volunteers.

Aim

The aim of this study was to investigate if a light breakfast of yoghurt or gruel empties from the stomach within four 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 four hours prior to induction. They were subsequently examined with gastric ultrasound within four hours of ingestion. In case of gastric contents, the gastric antral area was measured, and gastric content volume 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 gastric content volume in this patient was calculated to 2.1 ml kg-1. The patient with solids present had ingested 25 ml kg-1 of gruel four hours prior to assessment. The planned procedure was therefore delayed one hour. There were no cases of pulmonary aspiration or vomiting.

Conclusion:

A light breakfast four hours prior to induction may be considered, but there is need for further studies on safe limits for the volume ingested.

Keywords [en]
Ultrasound, General anesthesia, child < Age
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-394230OAI: oai:DiVA.org:uu-394230DiVA, id: diva2:1357989
Available from: 2019-10-05 Created: 2019-10-05 Last updated: 2019-10-10
In thesis
1. Reduced Preoperative Fasting in Children
Open this publication in new window or tab >>Reduced Preoperative Fasting in Children
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Preoperative fasting is recommended in order to reduce the risk of perioperative pulmonary aspiration. However, preoperative fasting may have negative effects on patient wellbeing and homeostasis. In this thesis, more lenient regimens for preoperative fasting in elective paediatric patients were assessed, with the aim to further improve preoperative fasting regimens.

Paper I investigated if paediatric patients allowed to drink clear fluids until called to surgery, had an increased risk of pulmonary aspiration. The incidence of perioperative pulmonary aspiration in children allowed free clear fluids until called to surgery was 3 in 10 000, as compared to 1-10 in 10 000 in previous studies where longer fasting intervals were studied. Hence, no increase of incidence for pulmonary aspiration was found.

Paper II investigated actual fasting times for clear fluids when applying two-hour fasting for clear fluids, and zero-hour fasting for clear fluids. When applying two-hour fasting, children were fasted median four hours for clear fluids. After transitioning to zero-hour fasting, median fasting time decreased to one hour, and the incidence of children fasting for more than six hours decreased from 35 % to 6 %. Abandoning the time limit for clear fluids significantly reduced the proportion of patients fasting for extended periods.

Paper III assessed gastric content volume after a light breakfast in children scheduled for elective general anaesthesia. Patients were examined with gastric ultrasound four hours after a light breakfast. Of the 20 patients included in the study, 15 had an empty stomach, 4 had clear fluids < 0.5 ml kg-1 and one had solid content in the stomach. A light breakfast preoperatively might be safe, but amount and caloric restriction is needed to avoid the risk of perioperative pulmonary aspiration.

Paper IV investigated preoperative weight loss, glucose level and ketone bodies in paediatric patients presenting for elective surgery. The outcomes were tested for correlation to preoperative fasting times. Of the 43 children enrolled in the study, three had weight loss of more than 5 %, five children presented with blood glucose level < 3.3 mmol l-1, and 11 children presented with ketone bodies > 0.6 mmol l-1. There was no correlation between fasting time, and the respective outcomes. Even with a lenient fasting regimen, there is risk of mild preoperative dehydration, hypoglycaemia and ketogenesis.

In conclusion, the results obtained in the present thesis supports the shift to more lenient preoperative fasting regimens for clear fluids in elective paediatric patients.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 62
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1600
Keywords
Fasting, Children, Preoperative, Pulmonary Aspiration
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-394232 (URN)978-91-513-0764-0 (ISBN)
Public defence
2019-11-22, Martin H:son Holmdahl-salen, Akademiska Sjukhuset, ingång 100, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2019-10-30 Created: 2019-10-06 Last updated: 2019-11-12

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Andersson, HannaFrykholm, Peter

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