Assessment of gastric residual volume by ultrasound before elective surgery in children according to the duration of preoperative fasting: a randomized controlled study
Abstract
INTRODUCTION: Minimizing unnecessary preoperative restrictions is a fundamental principle of the modern paradigm of enhanced recovery after surgery. OBJECTIVE: To evaluate the safety of administering 4 mL/kg of clear liquid two hours prior to elective anesthesia in children, based on ultrasound assessment of gastric residual volume. MATERIALS AND METHODS: In this single-center, prospective, randomized clinical trial a total of 38 children aged 6 to 17 years scheduled for elective surgery were examined and randomly divided into the main (I) and control (II) groups. In Group I (n = 18), children did not receive any food or liquid orally 12 hours before surgery, while in Group II (n = 17), drinking 4 mL/kg of fresh water was allowed 2 hours before surgery. Inclusion criteria: children under the age of 18 years; assessment of functional status according to the American Society of Anesthesiologists classification I–II. The volume of gastric contents was calculated using ultrasound. To assess the severity of thirst, a visual analog scale with three levels was used: 0–3 points indicated mild thirst, 4–6 points represented moderate thirst and 7–10 points denoted severe thirst. RESULTS: No complications of anesthesia and surgery, including aspiration of gastric contents, were reported. The medians of gastric residual volume in children in Group I and II did not have statistically significant differences: 0.34 (0.28–0.39) mL/kg vs. 0.36 (0.31–0.40) mL/kg (p = 0.766). The median glucose level was higher in Group I children: 4.5 (4.2–4.6) vs. 4.1 (3.9–4.5) (p = 0.014). Thirst intensity in children of the first group was 3 (3.00–4.75) points, versus 1 (0.0–1.5) points in children of the second group (p = 0.000). CONCLUSIONS: Drinking 4 mL/kg of fresh water two hours before surgery is a safe alternative to prolonged fasting without increasing the risk of aspiration of gastric contents.