Oral Contrast for Abdominal Computed Tomography in Children

Mahmoud, Mohamed; McAuliffe, John J.; Kim, Hwa-Young; Mishra, Pushkar; Salisbury, Shelia; Schnell, Beverly; Hirsch, Patricia; Arbabi, Shahriar; Donnelly, Lane F.

doi:10.1213/ane.0b013e3181f1bd6f

Cited by 18 publications

(7 citation statements)

References 29 publications

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“…We found that a significant proportion of patients had a median gastric fluid volume of greater than 0.4 mL/Kg and 1.5 mL/Kg (67% and 44%, respectively). These findings are similar to those of our previous retrospective analysis, where the residual gastric fluid volume exceeded 0.4 mL/Kg in 49% (178/365) of children receiving an abdominal CT who received an oral enteric contrast medium up to one hour before anesthesia/sedation [6].…”

Section: Discussionsupporting

confidence: 90%

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

Narayanasamy,

Fleck,

Kandil

et al. 2024

JCM

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Background: Gastric fluid volume has been used as a surrogate marker for pulmonary aspiration risk in studies evaluating fasting protocol safety. This study measured residual gastric fluid volume in children using a protocol in which diluted oral contrast medium was administered up until one hour before anesthesia. Methods: This was a single-center prospective observational cohort trial of 70 children for elective abdominal/pelvic computed tomography (CT). Imaging was performed after diluted enteral contrast medium administration, beginning two hours before and ending at least one hour before induction. For each patient, gastric fluid volume was calculated using an image region of interest. The primary outcome measure was gastric fluid volume measured using the computed tomography image. Results: The median time from the end of contrast administration to imaging was 1.5 h (range: 1.1 to 2.2 h). Residual gastric volume, measured using CT was <0.4 mL/Kg in 33%; ≥0.4 mL/Kg in 67%; and ≥1.5 mL/Kg in 44% of patients. Residual gastric volumes measured using CT and aspiration were moderately correlated (Spearman’s correlation coefficient = 0.41, p = 0.0003). However, the median residual gastric volume measured using CT (1.17, IQR: 0.22 to 2.38 mL/Kg) was higher than that of aspiration (0.51, IQR: 0 to 1.58 mL/Kg, p = 0.0008 on differences in paired measures). Three cases of vomiting were reported. No evidence of pulmonary aspiration was identified. Conclusions: Children who receive large quantities of clear fluid up to one hour before anesthesia can have a significant gastric residual volume.

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Section: Discussionsupporting

confidence: 90%

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

Narayanasamy,

Fleck,

Kandil

et al. 2024

JCM

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“…Procedural sedation is regularly performed in other settings in which fasting is frequently incomplete: cardiac catheterisation [80]; therapeutic abortions [81]; eye surgery [82][83][84][85]; and abdominal imaging in children who have first received oral contrast [86][87][88]. None of these settings have been identified as showing an increased aspiration risk.…”

Section: Absent Risk Factorsmentioning

confidence: 99%

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Green¹,

et al. 2019

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The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to 374 This statement presents the first fasting and aspiration prevention recommendations specific to procedural sedation.

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“…There is a long-standing debate in the literature whether oral contrast is a risk factor before induction of general anesthesia, but there are numerous case reports describing adverse pulmonary events in the setting of aspirated water-soluble and barium-based oral contrast agents, and several authors recommend forgoing contrast when possible before anesthesia. 26–28 Finally, there may be a benefit in terms of cost reduction. As enteral contrast is not very expensive (a liter of positive oral contrast costs less than $3.00), savings may be achieved primarily through shortened time in the ED, improving efficient use of scarce emergency medicine resources 14 and possibly increasing revenue for hospitals.…”

Section: Discussionmentioning

confidence: 99%

Enteral Contrast in the Computed Tomography Diagnosis of Appendicitis

et al. 2014

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Objective Our goal was to perform a comparative effectiveness study of intravenous (IV)-only versus IV + enteral contrast in computed tomographic (CT) scans performed for patients undergoing appendectomy across a diverse group of hospitals. Background Small randomized trials from tertiary centers suggest that enteral contrast does not improve diagnostic performance of CT for suspected appendicitis, but generalizability has not been demonstrated. Eliminating enteral contrast may improve efficiency, patient comfort, and safety. Methods We analyzed data for adult patients who underwent nonelective appendectomy at 56 hospitals over a 2-year period. Data were obtained directly from patient charts by trained abstractors. Multivariate logistic regression was utilized to adjust for potential confounding. The main outcome measure was concordance between final radiology interpretation and final pathology report. Results A total of 9047 adults underwent appendectomy and 8089 (89.4%) underwent CT, 54.1% of these with IV contrast only and 28.5% with IV + enteral contrast. Pathology findings correlated with radiographic findings in 90.0% of patients who received IV + enteral contrast and 90.4% of patients scanned with IV contrast alone. Hospitals were categorized as rural or urban and by their teaching status. Regardless of hospital type, there was no difference in concordance between IV-only and IV + enteral contrast. After adjusting for age, sex, comorbid conditions, weight, hospital type, and perforation, odds ratio of concordance for IV + enteral contrast versus IV contrast alone was 0.95 (95% CI: 0.72–1.25). Conclusions Enteral contrast does not improve CT evaluation of appendicitis in patients undergoing appendectomy. These broadly generalizable results from a diverse group of hospitals suggest that enteral contrast can be eliminated in CT scans for suspected appendicitis.

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Oral Contrast for Abdominal Computed Tomography in Children

Abstract: For children receiving an abdominal CT, the residual GFV exceeded 0.4 mL/kg in 49% (178/365) of those who received oral ECM up to 1 hour before anesthesia/sedation in comparison with 23% (11/47) of those who received IV-only contrast.

Cited by 18 publications

References 29 publications

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

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

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Enteral Contrast in the Computed Tomography Diagnosis of Appendicitis

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