Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Aug;34(8):768-772.
doi: 10.1111/pan.14923. Epub 2024 May 19.

An observational study of gastric contents in pediatric patients with long bone fracture using gastric ultrasound

Codruta N Soneru  1 , Anna N Reviere  1 , Timothy R Petersen  1   2   3 , Matthew R Paluska  4 , Donnis DeQuan Davis  5 , Ricardo J Falcon  1
Affiliations
Observational Study

An observational study of gastric contents in pediatric patients with long bone fracture using gastric ultrasound

Codruta N Soneru et al. Paediatr Anaesth. 2024 Aug.

Abstract

Background: The retention of gastric contents at surgery presentation is a risk factor for perioperative aspiration. A preoperative fasting (nil per os; NPO) interval is widely used to reduce this risk, but this approach is based on assumptions about the prevalence of typical gastric emptying rates. We assessed NPO guidelines' reliability with ultrasound (US) imaging and suction in pediatric patients presenting for single long-bone fracture repair after appropriate NPO intervals, when nearly all should have had empty stomachs.

Aims and methods: This prospective cross-sectional observational study comprised 200 pediatric surgical patients. As their NPO times varied by food/drink type, we defined "weighted NPO units" as the lowest multiple of elapsed recommended NPO times between consumption and surgery for each type of food or drink. We used US to image the stomach and its contents before anesthesia induction, followed by gastric suction. We evaluated the relationships between weighted NPO units, US gastric contents grade, opioid analgesic dosage and timing, and suctioned volume.

Results: Despite meeting typical NPO standards (median 14 h fasting), many patients retained nontrivial quantities of gastric contents at surgery. Weighted NPO units did not exhibit statistically-significant relationships with either suctioned volume or US grade. However, suctioned volume did correspond well to US grade.

Conclusion: NPO status may be a less reliable predictor of gastric contents at anesthesia induction in this patient population than has been assumed. Bedside US screening appears to provide more useful information for the planning of airway management.

Keywords: nil per os; aspiration; gastric contents; gastric emptying; pediatric fractures; ultrasound.

PubMed Disclaimer

References

REFERENCES

    1. Evain JN, Durand Z, Dilworth K, et al. Assessing gastric contents in children before general anesthesia for acute extremity fracture: an ultrasound observational cohort study. J Clin Anesth. 2022;77:110598. doi:10.1016/j.jclinane.2021.110598
    1. Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009;111(1):82‐89. doi:10.1097/ALN.0b013e3181a97250
    1. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011;114(3):495‐511. doi:10.1097/ALN.0b013e3181fcbfd9
    1. Terkawi AS, Karakitsos D, Elbarbary M, Blaivas M, Durieux ME. Ultrasound for the anesthesiologists: present and future. Sci World J. 2013;2013:683685. doi:10.1155/2013/683685
    1. American Society of Anesthesiologists. Patients taking popular medications for diabetes and weight loss should stop before elective surgery, ASA suggests. Accessed February 20, 2024. https://www.asahq.org/about‐asa/newsroom/news‐releases/2023/06/patients‐...

Publication types

LinkOut - more resources