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Background/Aims: Pulmonary aspiration of gastric content is a serious perioperative complication. The objective of this prospective study was to assess the relationship between the gastric volumes suctioned endoscopically and quantitative (antral cross‐section area) and qualitative (empty vs. nonempty) examination of the gastric antrum. Furthermore, the study aimed to determine the best antral cross‐section area cutoff value for a truly empty antrum in infants. Methods: This study was performed in a pediatric gastrointestinal endoscopy unit. Antral sonography was performed in supine and right lateral decubitus positions in 46 fasted infants prior to upper gastrointestinal endoscopic evaluation. Antral cross‐sectional area measurements in both positions and qualitative evaluation of the antrum (according to a three‐point grading system) were recorded. Gastric contents were endoscopically suctioned and measured. Results: Forty‐six patients (aged under 24 months) were included. According to the three‐point qualitative grading system, 76.1% of patients were classified as grade 0. The best cutoff value for the antral cross‐section area in the right lateral decubitus position, indicating an empty antrum, was determined to be 2.40 cm2. At this specific cutoff value, the sensitivity was 100%, the specificity was 68.6%, and the negative predictive value was 100%. Conclusions: Gastric ultrasonography can confirm an empty or nearly empty stomach in healthy infants. [ABSTRACT FROM AUTHOR]

Background: Liberal fasting regimens, which support clear fluid intake up to 1 h before surgery in children scheduled for elective surgery, are taking their place in guidelines. However, because of the lack of publications that investigate the gastric emptying time in preoperative obese children, the practice of 1‐hour clear fluid fasting in obese children remained at the level of recommendation with weak evidence. Aims: The primary aim was to investigate whether there is a difference in gastric emptying times between obese and non‐ obese children after preoperative intake of 3 mL/kg clear liquid containing 5% dextrose by using ultrasound. Methods: A total of 70 children were included in the study in two groups, 35 obese and 35 non‐obese, aged 6–14 years, who were scheduled for elective surgery. The baseline antral cross‐sectional area measurements of the children in the groups were made using ultrasound. 3 mL/kg 5% dextrose was consumed. Ultrasound was repeated immediately after fluid intake and every 5 min until the antral cross‐sectional area was at the baseline level. Results: The difference in median (IQR [range]) gastric emptying times (minutes) of non‐obese {35 [30.0–45.0 (20–60)]} and obese children {35 [30.0–40.0 (25–60)]} were not statistically significant (median of differences 0.0, 95% CI –5.0 to 5.0; p =.563). The antral cross‐sectional area and weight‐adjusted gastric volumes returned to the baseline level within 60 min after the intake of clear liquid with 3 mL/kg 5% dextrose in all children in both groups. Conclusions: Obese and non‐obese children have similar gastric emptying times, and these groups can be offered clear fluids containing 3 mL/kg 5% dextrose 1 h before the surgery. [ABSTRACT FROM AUTHOR]

Background: Emergency situations and conditions with impaired gastric emptying enhance the risk of perioperative pulmonary aspiration due to increased residual gastric contents volume (GCV). Gastric ultrasonographic (US) measurement of the gastric antral cross-sectional area (CSA) has been proposed to estimate preanesthetic GCV. However, only few healthy children and fasted pediatric patients have been investigated so far, predicting GCV with considerable imprecision. This study aimed to compare GCV assessed by US in different patient positions for measuring CSA, using magnetic resonance imaging (MRI) as reference, and to evaluate its potential as diagnostic test. Methods: Healthy volunteer children were examined in a crossover design on 2 days. After baseline examination, they received a light breakfast, followed by 7 ml·kg-1 clear fluid after 2 or 4 h. Gastric emptying was examined with MRI over 4 or 6 h, respectively. US was performed immediately after MRI in right lateral decubital (RLD) and supine with upper body elevated (SUBE) positions. Correlation coefficients (Pearson R; 95%CI) between CSA and body weight corrected GCV (GCVw) as determined by MRI volumetry were calculated. Data are presented as median (range). Results: Eighteen children aged 9.8 (6.8-12.2) years had 72 US examinations completed. CSA was 401 (101-1311) mm² and 271 (118-582) mm², and R between CSA and GCVw was 0.76 (0.76-1) and 0.57 (0.41-0.88) for the RLD and SUBE positions, respectively. The corresponding GCVw was 2.1 (0.1-13.8) ml·kg-1. A linear regression model from RLD was similar to one previously derived. Bland-Altman analysis and ROC plots are presented. Conclusion: CSA correlated with GCVw in healthy children over a wide range of gastric filling, with the RLD position clearly superior to the SUBE position, confirming a previously derived formula. Although direct calculation of GCVw is imprecise, this technique has the potential to become a diagnostic risk assessment test. [ABSTRACT FROM AUTHOR]