Preoperative clear fluid fasting and endoscopy-measured gastric fluid volume in children
Measured gastric fluid volume in children
October 2023 by Dr Pallavi Kumar
Study Type: Single-centre, prospective study in paediatric perioperative day care at a university-affiliated tertiary care centre.
- Aspiration of gastric fluid contents was performed in anaesthetised children aged 1-18 years undergoing elective gastroscopy.
- Recorded data included: patient fasting time, last meal content, last clear fluid content, aspirated gastric volume and pH, as well as patient characteristics.
- No significant correlation was observed between clear fluid fasting time and the child’s residual gastric fluid volume per kg body weight, nor between clear fluid fasting time and the pH of the residual gastric fluid.
Take Home Message/Commentary
1) This study does address a relevant and important question in clinical anaesthesia – given there has been a push to reduce the clear fluid fasting time from the standard 2 hours to one hour/zero hours.
2) There have been recent studies on similar questions, but there are no randomized controlled trials assessing the risk of pulmonary aspiration. Available observational studies are underpowered. As such it is difficult to exclude higher aspiration risk with shortened fasting time in a prospective manner due to prohibitive sample size required to identify change in outcome.
3) The strengths of this study are that it brings to light an important question in paediatric anaesthesia – should we shorten the clear fluid fasting time.
4) The limitations of this study are that it did not answer the question it asked, i.e., whether the clear fluid fasting time should be reduced to less than 2 hours. The shortest fasting time was 1 hour and 40 mins in this study.
5) This study is applicable to our practice and population – however it does not change practice given the fasting time of the patients were not of a short enough duration to determine whether less than two hours fasting time versus more than two hours fasting time was not adequately studied.