Gastric residual volumes and gastric ultrasound in young children fed with breast milk 3 hours prior to general anesthesia: A prospective observational study

Aims: The volume of gastric contents that might be expected at anesthetic induction following a 3-hour breast milk fast has not yet been investigated. The role of gastric ultrasound in quantifying particulate gastric content is also undefined. The primary objective of this study is to assess the gastric residual volume (GRV) measured by gastric suctioning in children who are breast fed 3 hours prior to general anesthesia. The secondary objective is to compare measured and predicted GRV, using a published formula derived from a gastric ultrasound study in infants. Method: An observational prospective study of children aged 37 weeks to 18 months, fed 3 hours prior to general anesthesia was performed at 2 tertiary pediatric centers. Assessment of gastric antrum was performed using gastric ultrasound. The correlation between predicted and measured gastric residual volume was investigated using Pearson’s correlation coefficient. Results: Data from 44 general anesthetics performed in 42 children, with a median age of 9.5 months, and a median fasting time of 180 minutes are reported (range 150–210 minutes). Median GRV was 0 mL kg−1 (IQR 0–0.1). Correlation between predicted and actual gastric residual volume by aspiration was weak (r = 0.42, p = 0.007). Conclusion: For breast milk fasting intervals of 3 hours, GRV was low and comparable to an overnight fast in this small study. The limited feasibility of performing awake gastric ultrasound in this age group, and therefore limitations as a clinical tool are discussed.