The recent liberalization of preoperative feeding orders in healthy pediatric outpatients prompts the question of whether this applies to children about to have cardiac surgery. The authors compared gastric fluid volume and pH in two groups of children undergoing elective cardiac surgery, one of which was not only permitted ad libitum clear liquids but was mandated to drink clear liquids 2–3 h before induction of anesthesia (study group). The other group followed routine inpatient preoperative fasting orders (control group). The study group (n = 44) averaged 3.1 ± 4.1 yr and weighed 15.3 ± 16.3 kg; the control group averaged 3.3 ± 3.9 yr and weighed 14.3 ± 12.1 kg (P = 0.82, 0.73, respectively). Aspiration of residual gastric fluid volume was attempted in all patients after induction of anesthesia. Gastric fluid volume averaged 0.6 ± 0.9 mL/kg in the study group and 0.4 ± 0.6 mL/kg in the control group (P = 0.13). Of the study patients, 41% had a measured gastric volume ≥0.4 mL/kg compared with 32% of the control patients (P = 0.50). Of the 42 patients who had residual gastric fluid aspirated, pH determinations were completed on 37 aspirates; of these 19 of 20 (95%) in the study group and 14 of 17 (82%) in the control group had a gastric pH ≤2.5. Using a linear analogue scale, parents rated children in the study group to be more comfortable, less hungry, and less thirsty compared with the control patients (P = 0.004, 0.002, 0.0001, respectively). The authors conclude that children scheduled for cardiac surgery may be allowed to drink clear liquids up to 2 h before induction of anesthesia without adversely affecting the volume of residual gastric fluid or the percentage of patients with a pH ≤2.5. Ingestion of clear liquids by these children, as in healthy pediatric outpatients, appears to add no additional risk and makes the preoperative experience more pleasant.
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Nicolson et al. (1992) studied this question.