Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia

Tudor-Drobjewski, Bianca-Andreea; Marhofer, Peter; Kimberger, Oliver; Huber, Wolf Dietrich; Roth, Georg A.; Triffterer, L.

doi:10.1016/j.bja.2018.04.040

Cited by 41 publications

(38 citation statements)

References 20 publications

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“…Conventional two‐dimensional ultrasonography is sufficiently valid for assessing gastric emptying in children. In our present study, the variations and tendencies of LnGFV and antral CSA in both groups are consistent with those reported in a previous study 31. Therefore, more precise methods using scintigraphy, three‐dimensional ultrasound, and magnetic resonance imaging may not be necessary for assessing gastric emptying in children 27,32 …”

Section: Discussionsupporting

confidence: 92%

“…It can assess the type (ie nothing, clear fluid, or thick fluid/solid) and volume of gastric content. In recent studies regarding gastric emptying, ultrasound examinations were extensively used for evaluating the volume of gastric content 30,31 . Ultrasound has also been used to assess gastric content to determine the types of induction of general anesthesia in infants with hypertrophic pyloric stenosis and in nonelective pediatric surgery 21,30 .…”

Section: Discussionmentioning

confidence: 99%

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Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate‐rich drink in young children: A randomized crossover study

Zhang

Zeng

et al. 2020

Pediatric Anesthesia

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Background A recent consensus statement in Europe has suggested that the fasting time for clear liquid in children can be shortened to 1 hour before a surgery. However, the study to show that 1‐hour fasting time for clear fluids is safe in young children is still lacking. This study aimed to investigate the gastric emptying time for carbohydrate‐rich drink and regular 5% glucose solution in children aged 3‐7 years. Methods After overnight fasting, individuals were randomly assigned to ingest 5 mL kg−1 of either carbohydrate‐rich drink or 5% glucose solution. One week later, the same subjects were asked to ingest the other one. Ultrasonography was performed to examine the gastric contents. Gastric antral cross‐sectional area was measured, and the gastric fluid volume was calculated before and after fluid ingestion within 120 minutes. The primary outcome was the gastric emptying time for both the clear fluids calculated using the antral cross‐sectional area and logarithms of gastric fluid volume. The degrees of thirst and hunger of two drinks were evaluated using a visual analogue scale as the secondary outcomes. Results Data from 16 individuals were analyzed. In the glucose solution group, the antral cross‐sectional area and logarithms of gastric fluid volume returned to baseline at 30 minutes after ingestion. However, in the carbohydrate‐rich drink group, the median [interquartile range; range] antral cross‐sectional area (3.69 [2.64‐5.15; 1.83‐8.93] cm2 vs 2.41 [2.10‐2.96; 1.81‐4.37] cm2, P < .001) and mean (95% confidence interval) logarithms of gastric fluid volume (2.54 [2.30‐2.79] mL vs 2.12 [1.94‐2.30] mL, P = .048) were still higher than at 60 minutes and returned to the baseline values at 90 minutes after ingestion, respectively. The degree of thirst was lower in the glucose solution group than that in the carbohydrate‐rich drink group. Conclusions Gastric emptying of carbohydrate‐rich drink is slower than that of 5% glucose solution but the residual gastric fluid volume is low one hour after ingestion of 5 mL kg−1 of either fluid.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate‐rich drink in young children: A randomized crossover study

Zhang

Zeng

et al. 2020

Pediatric Anesthesia

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“…In a study of 120 children (2–18 years) scheduled for gastroscopy, consumption of lemon-flavoured carbohydrate beverage reduced the mean volume of gastric contents compared to water or tea administered 2 h prior to induction of anaesthesia (LOE – High). [ 253 ] The residual gastric volume was comparable when 6 or 10 mL/kg apple juice was consumed 2.5 h before induction of anaesthesia compared to overnight fasting in children aged 5–10 years (LOE – Moderate). [ 254 ]…”

Section: Paediatric Sectionmentioning

confidence: 99%

“…[ 248 249 250 251 252 ] The gastric pH was comparable in children 2–18 years age both with consumption of lemon-flavoured carbohydrate beverage or non-carbohydrate beverage (water or tea) 2 h prior to the procedure (LOE – Moderate). [ 253 ] Comparable pH was found when 6-10 mL/kg apple juice was consumed 2.5 h before induction of anaesthesia compared to overnight fasting in children aged 5–10 years (LOE – Moderate). [ 254 ]…”

Section: Paediatric Sectionmentioning

confidence: 99%

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

et al. 2020

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“…Patients' general well-being (thirst, hunger, mouth dryness, nausea, vomit and fatigue) was measured by VAS in this study. VAS scores 0-10 were assessed before intravenous anesthesia (21). Score 0 means patients have no discomfort at all and score 10 presents patients have the most severe discomfort.…”

Section: Vas Scorementioning

confidence: 99%

Effects of Preoperative Oral Carbohydrate on Cirrhotic Patients Under Endoscopic Therapy with Anesthesia: A Randomized Controlled Trial

Wang

Liu

et al. 2020

Preprint

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Background: Preoperative fasting is a major cause of perioperative discomfort in patients. Addressing this problem by preoperative oral carbohydrate (POC) has been recommended as an important element of the enhanced recovery after surgery (ERAS) protocol, but its effect on cirrhotic patients who tend to show abnormalities in gastric emptying function has not yet been clarified. Our study aims to investigate the influence of POC on gastric empting and preoperative well-being in cirrhotic patients. Methods: A prospective, randomized and controlled study of cirrhotic patients with gastroesophageal varices scheduled for elective endoscopic therapy under intravenous anesthesia was conducted. 180 patients were enrolled in this study. Patients were divided into three groups: those not supplement with carbohydrate for 8h prior to endoscopic therapy (Control group), those given a carbohydrate beverage 2h (2h group) or 4h (4h group) prior to endoscopy. Gastric emptying was evaluated by gastric sonography score and collecting gastric content aspirated endoscopically before anesthesia. Stresses caused by examination associated fasting were evaluated by visual analogue scale (VAS) scores for six parameters (thirst, hunger, mouth dryness, nausea, vomit and weakness) preoperatively. Hemodynamic changes, peristole and postoperative complications were also recorded. Results: Before anesthesia, gastric sonography score was similar among three groups. In addition, no patient had residual gastric volume more than 1.5ml/kg in control and 4h group, but six patients (11%) reached a residual gastric volume of more than 1.5ml/kg in 2h group. Moreover, compared with control fasting, VAS scores for six parameters (thirst, hunger, mouth dryness, nausea, vomiting and fatigue) in 2h group and for three parameters (thirst, hunger and mouth dryness) in 4h group were both significantly lower. Gastric peristaltic score and operation score before operation, postoperative complication, lengths of hospital stay and in-hospital expense were not significantly different among three groups.Conclusions: For the first time, we demonstrate that avoiding preoperative fasting with oral carbohydrates given 4h prior to anesthesia can improve preoperative well-being feelings, without enhancing the risk of aspiration and regurgitation in cirrhotic patients. Our study adds knowledge for preoperative fasting guidelines in anesthesia for cirrhotic patients. Trial registration: This trial was registered at Clinicaltrials.gov under the number ChiCTR2000032394.

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Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia

Abstract: DRKS00005020.

Cited by 41 publications

References 20 publications

Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate‐rich drink in young children: A randomized crossover study

Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate‐rich drink in young children: A randomized crossover study

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

Effects of Preoperative Oral Carbohydrate on Cirrhotic Patients Under Endoscopic Therapy with Anesthesia: A Randomized Controlled Trial

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