Gastric volume and its relationship to underlying pathology or acid-suppressing medication

Abstract

Background:Pulmonary aspiration during sedation is a major concern for sedation providers, making identifying high-risk patients a priority. Gastric fluid volume (GFV), an accepted risk factor for aspiration, has not been well characterized in fasting children. We hypothesized that GFV would increase with gastrointestinal (GI) pathology and decrease with regular acid-suppressor use.Aims:The primary objective was to determine baseline GFV in fasting children. The secondary objectives were to evaluate the effect of GI pathology and regular use of acid-suppressing medications on GFV.Settings and Study Design:This was prospective, observational study.Materials and Methods:We endoscopically aspirated and measured GFV of 212 children fasting for >6 h who were sedated for esophagogastroduodenoscopy (EGD). Inclusion criteria were children up to 21 years of age, with the American Society of Anesthesiologists physical Status I and II presenting for elective EGD. After determining baseline GFV, the effect of GI pathology and effect of regular acid-suppressing medication use on GFV was analyzed.Statistical Analysis:Analysis of variance was used to compare the GFV among ages and pathology and medication groups. Student's t-test was used to compare GFV between genders and also to compare GFV in confounder analyses.Results:For the studied 212 children, average GFV was 0.469 ± 0.448 mL/kg (0–2.663 mL/kg). We found no association between GI pathology and GFV (P = 0.147), or acid-suppressor use and GFV (P = 0.360).Conclusions:Average GFV in this study falls within the range of prior EGD-measured GFV in fasting children. Contrary to our hypothesis, we found no association between pathologies or regular acid-suppressor use on GFV. On the basis of GFV, children with GI disorders or those using acid-suppressors do not appear to pose an increased risk of aspiration. Future studies should discern differences in effects on GFV of immediate preprocedural versus the regular use of acid-suppressing medications.

Assessing Residual Gastric Fluid Volume after Administering Diluted Oral Contrast until One Hour Prior to Anesthesia in Children: An Observational Cohort Study

“…Our approach to measuring the gastric fluid volume via CT imaging, which is a standard and accepted technique for volume measurement in radiology [ 9 , 10 ] and bariatric surgery [ 11 ], was different from the methods used in previous studies, which measured gastric fluid volumes by using blind aspiration of the gastric contents [ 21 , 22 ], ultrasound assessment [ 28 , 29 , 31 ], or magnetic resonance imaging [ 27 ]. This was a practical choice because all our study patients were undergoing abdominal CT scans.…”

“…The primary outcome measure was gastric fluid volume ≥ 0.4 mL/Kg, measured during the CT scan within two hours of sedation via CT calculation using a region of interest. A gastric fluid volume of 0.4 mL/Kg was chosen because, according to several studies, 0.4 mL/Kg was found to be the average gastric fluid volume of fasting pediatric patients [ 21 ] Similarly, Wittgrove and colleagues found an average gastric fluid volume of 0.469 mL/Kg in 212 children aged between six months and 21 years who fasted for six hours prior to elective esophagogastroduodenoscopy [ 22 ]. Other studies of fasted children found gastric fluid volumes from 0.35 to 0.68 mL/Kg [ 23 , 24 , 25 ].…”

Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists

“…[ 260 ] Gender, age, gastrointestinal pathology or pH-altering medication does not appear to have an effect on the GFV (LOE – Very Low). [ 261 ] Thus, as per the evidence, aspiration prophylaxis may not be uniformly effective in improving the gastric pH and reducing the residual gastric volume in adequately fasted children.…”