Safe pre‐operative fasting times after milk or clear fluid in childrenA preliminary study using real‐time ultrasound

Abstract

Gastric emptying of orange‐flavoured glucose (group I), low‐fat milk (group II) and breast milk (group III) was evaluated in 45 ASA grade I children of ≤ 5 years of age by using real‐time ultrasonography and residual gastric volume and pH was then measured. In 15 more children, residual gastric volume and pH was measured after a midnight fast (group IV). Mean (SD) gastric emptying time in group I was 1.53 (0.25) h (range 1.00–1.75), group II 2.32 (0.31) h (range 1.75–2.75) and group III 2.43 (0.27) h (range 2.00–2.75). According to Robert and Shirley's criteria, no children of group I and II were found to be ‘at risk’ at 2 h and 3 h, respectively, but 13.3% of group III children were labelled as ‘at risk’ at 3 h. The incidence of ‘at risk’ children in group IV was 33.3%. It was concluded that 3% fat milk or 17.5% glucose in a volume of 10 ml.kg−1 (maximum volume of 100 ml) can be given in children safely 3 h and 2 h, respectively, before anaesthesia. More real‐time studies are required on breast milk to establish guidelines for its potential use as a pre‐operative feed 3 h before anaesthesia.

Assessment of Pre-Gastroscopy Fasting Period Using Ultrasonography

“…The gastric passage of fluids containing fat such as milk is slower than the passage of clear fluids containing glucose, thus leading to a minimal 3 h fasting period after the consumption of milk [18], which is also considered too short by some anaesthesiologists [19]. Consistent with previous studies we observed a delay of gastric emptying after ingestion of apple juice or glucose solution as compared with that of water [1].…”

ABM Clinical Protocol #25: Recommendations for Preprocedural Fasting for the Breastfed Infant: “NPO” Guidelines

“…Gastric emptying time for cow's milk can also take up to 6 hours, similar to that of solids, although some studies show that it can empty almost as fast as HBM. 17 Although some studies have demonstrated that HBM empties within 2-3 hours, 15,17-20 gastric emptying times of HBM vary from infant to infant, and fat content of HBM is not consistent. 21 The ASA perioperative task force on sedation recommends a four-hour fast from HBM due to individual variation in gastric emptying and human milk content, though this may differ from international recommendations.…”

Pr�operative Nahrungskarenz

“…Kindern konnte festgestellt werden, dass im Mittel 2,32 h nach Aufnahme von 10 ml/kg KG Kuhmilch mit einem Fettgehalt von 3% und 2,43 h nach dem Stillen mit Muttermilch der Magen entleert war[48].Aufgrund der im allgemeinen mangelhaften Datenlage zur Einschätzung einer sicheren präoperativen Nüchtern-heitsphase für fetthaltige Getränke wie Kuhmilch empfiehlt die ASA für Patienten aller Altersklassen eine Karenzzeit von 6 h und stellt sie somit ihren Empfehlungen für das Fasten hinsichtlich einer kleinen Mahlzeit gleich[2]. Bezüglich des Stillens von Neugeborenen wird eine…”