Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients: A prospective cohort study

This single centre study, conducted at a university hospital in France, aimed to assess the prevalence of an “at risk stomach” in children undergoing elective surgery. This was defined as solid content in the antrum and/or a gastric volume >1.25ml/kg.

Two hundred consecutive paediatric patients (1-16 years) undergoing elective surgery had a preoperative gastric ultrasound (USS) examination by a blinded single investigator. This consisted of assessment of two parameters;
1. Gastric volume derived from the cross sectional area of the antrum.
2. Previously described 3 point grading scale.
a. Grade 0 = no content in antrum
b. Grade 1 = fluid content in right lateral decubitus
c. Grade 2 = fluid content also in supine position

The median fasting times for clear fluids and solids were 4 and 13.5 hours respectively. No solid content was demonstrated in any of the patients. 57%, 80% and 40% of patients had a grade O, 1 and 2 antrum respectively. Median gastric volume was 0.48mls/kg. Two patients had a gastric volume >1.25mls/kg. They were both males, aged 2-5 years, ASA 1, undergoing ENT surgery who were both sufficiently fasted according to guidelines. An “at risk stomach” was demonstrated therefore in 1% (2 patients).

There was a statistically significant difference between gastric volume and the 3 point grading scale. Those with higher Grade antrum, having more gastric volume per unit weight.

Take home message

This demonstrates a simple non-invasive technique to screen for paediatric patients at a potentially increased risk of aspiration. However, the yield of results is low and requires training of the proceduralist to develop competence in this technique.

Unfortunately, the paper does not comment on the incidence of regurgitation or aspiration during the study and therefore does not allow potential for correlation with gastric USS findings.

Reviewed by: Sorcha Evans