“Full Stomach” Despite the Wait: Point‐of‐care Gastric Ultrasound at the Time of Procedural Sedation in the Pediatric Emergency Department

Abstract

Objectives:The objective was to use gastric point-of-care ultrasound (POCUS) to assess gastric contents and volume, summarize the prevalence of "full stomach," and explore the relationship between fasting time and gastric contents at the time of procedural sedation.Methods: This was a prospective study of patients aged 2 to 17 years fasting prior to procedural sedation. A single sonographer scanned each patient's gastric antrum in two positions: supine with the upper body elevated and right lateral decubitus (RLD). Gastric content (empty, liquid, or solid) was noted, and the gastric volume (mL/ kg) was estimated from antral cross-sectional area (CSA). "Full stomach" was defined as any solid content or >1.2 mL/kg of liquid gastric content.Results: We enrolled 116 subjects, with a median fasting time of 5.8 hours. Of the 107 with evaluable images, 74 patients, 69% (95% confidence interval [CI] = 60%-77%), were categorized as having a full stomach. Each hour of fasting was associated with lower odds (odds ratio = 0.79, 95% CI = 0.65-0) of a full stomach. However, the knowledge of fasting time alone provides little ability to discriminate between risk groups (C-index = 0.66).Conclusions: Gastric POCUS classified many patients as having a full stomach at the time of expected procedural sedation, despite prolonged fasting times. These findings may inform risk-benefit considerations when planning the timing and medication choice for procedural sedation.

Ultrasound assessment of gastric contents in children before general anaesthesia for acute appendicitis

“…In our cohort of children with acute appendicitis, gastric contents were not associated with the duration of fasting or abdominal pain. Recent ultrasound studies have likewise reported a poor correlation between gastric contents and fasting time in acutely ill children, both in the emergency department [21][22][23] and in the operating theatre [9].…”

Gastric point-of-care ultrasound evaluation in pediatric emergency department procedural sedation patients; is the stomach empty at the point of scheduled revisit?

“…In our study, 82% of patients showed an empty stomach after a median NPO time of 7.5 hours for solid intake and 6 hours for clear liquid intake. This study included a population with lower age group, weight, and height but similar body mass index than in other studies [20][21][22]34]. The ROC analysis suggested the optimal cut-off of solid food NPO duration for gastric emptying was 6.5 hours when the patients had more than 2 hours of liquid fasting.…”

“…Recent studies have investigated the prevalence of an empty stomach on gastric POCUS in pediatric patients requiring PSA in the PED. Leviter et al [21] reported that only 31% of patients had an empty stomach after 5.8 (4.6-7.7) hours of solid fasting and 5.2 (4.1-6.8) hours after liquid fasting. Moake et al [22] conducted a study on 93 patients with PSA, and reported that gastric emptying could be confirmed in only 20% of patients fasting more than 6 hours and in less than 40% of patients fasting for more than 8 hours.…”

“…The reason for fasting is to ensure gastric emptying, and it has been reported that patients undergoing unscheduled procedures have significantly delayed gastric emptying times, unlike patients undergoing elective surgery [20]. Recently, studies that confirmed "full stomach" using a gastric POCUS in children undergoing PSA in PED have been reported, and these studies found that the frequency of an empty stomach even after 6 hours of fasting as called for by the ASA recommendation is quite low [21,22]. We questioned whether delayed gastric emptying in the PED was similar in patients with a scheduled revisit.…”

Ultragarsinio Tyrimo Panaudojimas Pediatrinėje Anestezijoje

“…Šiuo metu trūksta daugiau tyrimų ir naujesnių duomenų apie skrandžio turinio įvertinimą vaikų populiacijoje, todėl negalime teigti, jog vienas ar kitas metodas yra pranašesnis. Remiantis literatūra, badavimas, trunkantis 6 ar daugiau valandų, neužtikrina tuščio skrandžio vaikų populiacijoje [56], todėl siekiant išvengti su aspiracija susijusių komplikacijų, turėtų būti svarstoma skrandžio turinio įvertinimo UG galimybė.…”