Preoperative assessment of paediatric gastric residual volume after consumption of a carbohydrate-containing drink using gastric ultrasound

Abstract

Background: Fasting guidelines in paediatric patients aim to prevent regurgitation and aspiration during anaesthesia. The European Society of Anaesthesiology and Intensive Care recommends a 2-h fasting period for carbohydrate-containing fluids.
Aim: This study aimed to compare gastric residual volumes (GRVs) in children at three time intervals after preoperative consumption of an oral carbohydrate-rich drink (OCD).
Setting: This study was conducted at Charlotte Maxeke Johannesburg Academic Hospital.
Methods: This prospective, single-centre study was conducted from November 2023 to April 2024 and included paediatric patients aged 2–18 years undergoing elective orthopaedic procedures who adhered to fasting guidelines and consumed 3 mL/kg of an OCD. Gastric residual volume was assessed with ultrasound at baseline, 1- and 2-h intervals post-ingestion. Statistical analyses were performed to evaluate changes in GRV between children and the change in each child over time.
Results: Thirty-three children were included in the study. The study found no significant differences in mean GRV across the three time points, with all values remaining below the safe aspiration threshold of 1.5 mL/kg. Qualitative assessments showed that GRV decreased below baseline levels by 2 h. One-third of patients reported thirst preoperatively, but none experienced intraoperative hypoglycaemia or postoperative nausea or vomiting.
Conclusion: The consumption of a modest volume of an OCD up to 1 h before surgery did not significantly increase GRV in paediatric patients.
Contribution: These findings support the safety of preoperative carbohydrate intake at 1 h preoperatively, aligning with recent guidelines that advocate for reduced fasting times to enhance patient outcomes.