Ultrasound assessment of gastric emptying after breakfast in healthy preschool children

Abstract

The results of the balloon experiment showed a high correlation between balloon antral area and balloon volume. In the preschool child measurements, gastric antral area correlated with fasting time, and the mean gastric emptying time was lower than 4 hours after breakfast. These results support a more liberal perioperative fasting regimen after a light meal or breakfast in routine pediatric anesthesia.

Real fasting times and incidence of pulmonary aspiration in children: Results of a German prospective multicenter observational study

“…To overcome these problems, more liberal fasting regimens and better interdisciplinary cooperation would be beneficial. Andersson et al showed that dispensing with the 2 hours fasting limit for clear fluids was not associated with an increased incidence of pulmonary aspiration, and other studies found that the stomach processes a light meal in less than 4 hours . For a better implementation of improved fasting regimens, Newton et al favored a structured quality improvement program leading to an increased proportion of children fasting less than 4 hours after the introduction of a standard operating procedure checking the fasting status on admission and allowing clear fluids up to 1 hour before anesthesia.…”

“…Andersson et al 3 showed that dispensing with the 2 hours fasting limit for clear fluids was not associated with an increased incidence of pulmonary aspiration, and other studies found that the stomach processes a light meal in less than 4 hours. 6 Children with an expected waiting time of more than 4 hours should receive a standardized light meal in the morning. 7 In addition, all infants and children should be allowed to drink clear fluids liberally up to 1 hour before anesthesia.…”

“…Shortened fasting times may improve the metabolic and hemodynamic condition during induction of anesthesia and the perioperative experience for parents and children with a low risk of aspiration and simplify perioperative management. As a consequence, some centers have reduced the fasting requirements for clear fluids to 1 hour and for light meals to 4 hours . In a recent review, Frykholm et al suggested that this change should be done ideally within a framework of a large multicenter audit monitoring the benefits and safety of the more liberal fasting regimen.…”

“…As a consequence, some centers have reduced the fasting requirements for clear fluids to 1 hour 4 and for light meals to 4 hours. [5][6][7] In a recent review, Frykholm et al 8 suggested that this change should be done ideally within a framework of a large multicenter audit monitoring the benefits and safety of the more liberal fasting regimen. Building on this discussion, the Scientific Working Group for Pediatric Anesthesia (WAKKA) of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) proposed in its annual meeting in 2018 to prepare a revision of the national fasting guidelines for children 9 (presently 6 hours for solids, 4 hours for breast or formula milk and 2 hours for clear fluids) and to initiate an accompanying prospective multicenter observational study evaluating real fasting times and the incidence of regurgitation and pulmonary aspiration during routine pediatric anesthesia in major centers in Germany before guideline revision.…”

Leading papers in pediatric anesthesia from the last year

“…O POCUS para avaliação do conteúdo gástrico pode ser usado para sustentar uma rotina mais liberal no jejum pré-operatório de crianças. No artigo de Sumpelmann et al 28 , foi conduzido um estudo observacional e experimental. Balões em formato de pera eram preenchidos com 500 mL de água e esvaziados em incrementos de 50 mL.…”