Ultrasound-Based Assessment of Gastric Fluid Volume in the Pediatric Population Undergoing Elective Surgery: A Prospective, Randomized, Double-Blind Comparison of Carbohydrate-Rich Clear Fluid Versus Water at One- and Two-Hour Fasting Intervals.
Aruna Parameswari, Amrit Kumar Som, Kishore Manivannan et al.
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In 30 seconds
This prospective, randomized, double-blind trial compared gastric fluid volume (GFV) after 3 mL/kg of 10% glucose solution or water, followed by a one- or two-hour fast, in 140 healthy children aged 1–12 years undergoing elective non-gastrointestinal surgery. Ultrasound-measured mean GFV was highest after glucose with a one-hour fast (0.947 ± 0.225 mL/kg) and lowest after water with a two-hour fast (0.268 ± 0.322 mL/kg; overall p < 0.001). No child exceeded 1.5 mL/kg, and no aspiration occurred. Comfort scores were higher with one-hour glucose than with two-hour water fasting.
Key findings
- Mean GFV was 0.947 ± 0.225 mL/kg after glucose and a one-hour fast, versus 0.340 ± 0.317 mL/kg after glucose and a two-hour fast.
- No participant in any group had GFV above 1.5 mL/kg; no pulmonary aspiration occurred.
- Perlas Grade 2 was observed in 31.4% of the one-hour glucose group and 8.6% of the one-hour water group, with none in the two-hour groups.
- Comfort scores were higher with one-hour glucose fasting than with two-hour water fasting (8.31 ± 0.63 vs 6.66 ± 0.97; p < 0.001).
Why it matters
The trial provides quantitative ultrasound data on gastric contents after abbreviated clear-fluid fasting in children, including carbohydrate-rich fluid. The higher measured volumes after one-hour fasting are relevant to aspiration-risk assessment, while the absence of volumes above the study’s 1.5 mL/kg threshold and the improved comfort scores inform evaluation of shorter fasting intervals.
What to keep in mind
The study involved healthy children undergoing elective non-gastrointestinal surgery at a tertiary referral centre; its findings do not establish safety in other pediatric populations or settings. No aspiration events occurred, so the trial cannot quantify aspiration risk.