Gastric point-of-care ultrasound evaluation in pediatric emergency department procedural sedation patients; is the stomach empty at the point of scheduled revisit?
1Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 10326 Goyang, Republic of Korea
2Department of Emergency Medicine, Inje University College of Medicine and Seoul Paik Hospital, 04551 Seoul, Republic of Korea
Submitted: 25 March 2021 Accepted: 21 May 2021
Online publish date: 22 June 2021
Objectives: This study aimed to use gastric point of care ultrasound (POCUS) to estimate the prevalence of an “empty stomach” among patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED) after observing the requisite fasting time at home.
Methods: A prospective observational study was conducted with children with facial lacerations who made a scheduled revisit to the ED after completion of the recommended fasting time. Their stomach contents were assessed with a sagittal view of the gastric antrum by POCUS in the right lateral decubitus position. The characteristics of gastric contents were described as empty, solid, and liquid with an estimated gastric volume. “Empty stomach” was defined as a collapsed gastric antrum or calculated a gastric fluid volume of less than or equal to 1.25 mL/kg on POCUS.
Results: Gastric POCUS was performed in 125 patients, and the final analysis included 122 patients. For 95 patients who had followed the recommended fasting time, the median fasting time was 7 hours for solids and 6 hours for liquids, and 78 (82%) patients had an empty stomach. Conversely, seven of 27 patients (26%) who did not have an adequate fasting time had an empty stomach. The optimal cut-off value of fasting time to predict an empty stomach was 6.5 hours based on a receiver operating characteristic (ROC) analysis (sensitivity = 0.767, specificity = 0.811).
Conclusions: Most scheduled revisiting children had an “empty stomach” at the time of sedation after the recommended fasting. However, providers should be aware that one in five children still had stomach residue, although they had more than 6 hours of fasting.
Ultrasonography; Gastric emptying; Pediatrics
Howon Na,Han Ho Do,Seung Chul Lee,Jeong Hun Lee,Jun Seok Seo,Yong Won Kim,Sanghun Lee,Chu Hyun Kim. Gastric point-of-care ultrasound evaluation in pediatric emergency department procedural sedation patients; is the stomach empty at the point of scheduled revisit?. Signa Vitae. 2021.doi:10.22514/sv.2021.109.
 Sahyoun C, Cantais A, Gervaix A, Bressan S, Löllgen R, Krauss B. Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice. European Journal of Pediatrics. 2021; 180: 1799–1813.
 Krauss B, Green SM. Procedural sedation and analgesia in children. The Lancet. 2006; 367: 766–780.
 Melendez E, Bachur R. Serious Adverse Events during Procedural Sedation with Ketamine. Pediatric Emergency Care. 2009; 25: 325–328.
 Tobias JD, Leder M. Procedural sedation: a review of sedative agents, monitoring, and management of complications. Saudi Journal of Anaesthesia. 2011; 5: 395–410.
 Beach ML, Cohen DM, Gallagher SM, Cravero JP. Major Adverse Events and Relationship to Nil per Os Status in Pediatric Sedation/Anesthesia outside the Operating Room: A Report of the Pediatric Sedation Research Consortium. Anesthesiology. 2016; 124: 80–88.
 Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH. The Incidence and Nature of Adverse Events during Pediatric Seda-tion/Anesthesia with Propofol for Procedures outside the Operating Room: A Report from the Pediatric Sedation Research Consortium. Anesthesia & Analgesia. 2009; 108: 795–804.
 Green SM, Roback MG, Kennedy RM, Krauss B. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update. Annals of Emergency Medicine. 2011; 57: 449–461.
 Frykholm P, Schindler E, Sümpelmann R, Walker R, Weiss M. Preoperative fasting in children: review of existing guidelines and recent developments. British Journal of Anaesthesia. 2018; 120: 469–474.
 Murat I, Constant I, Maud’huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatric Anaesthesia. 2004; 14: 158–166.
 Borland LM, Sereika SM, Woelfel SK, Saitz EW, Carrillo PA, Lupin JL, et al. Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome. Journal of Clinical Anesthesia. 1998; 10: 95–102.
 Warner MA, Warner ME, Warner DO, Warner LO, Warner EJ. Periopera-tive pulmonary aspiration in infants and children. Anesthesiology. 1999; 90: 66–71.
 Agrawal D, Manzi SF, Gupta R, Krauss B. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Annals of Emergency Medicine. 2003; 42: 636–646.
 Roback MG, Bajaj L, Wathen JE, Bothner J. Preprocedural fasting and adverse events in procedural sedation and analgesia in a pediatric emergency department: are they related? Annals of Emergency Medicine. 2004; 44: 454–459.
 Green SM, Mason KP, Krauss BS. Pulmonary aspiration during procedural sedation: a comprehensive systematic review. British Journal of Anaesthesia. 2017; 118: 344–354.
 Bhatt M, Johnson DW, Taljaard M, Chan J, Barrowman N, Farion KJ, et al. Association of Preprocedural Fasting with Outcomes of Emergency Department Sedation in Children. The Journal of the American Medical Association Pediatrics. 2018; 172: 678–685.
 Chumpitazi CE, Camp EA, Bhamidipati DR, Montillo AM, Chantal Caviness A, Mayorquin L, et al. Shortened preprocedural fasting in the pediatric emergency department. The American Journal of Emergency Medicine. 2018; 36: 1577–1580.
 Green SM, Roback MG, Krauss BS, Miner JR, Schneider S, Kivela PD, et al. Unscheduled Procedural Sedation: a Multidisciplinary Consensus Practice Guideline. Annals of Emergency Medicine. 2019; 73: e51–e65.
 Coté CJ, Wilson S. Guidelines for Monitoring and Management of Pediatric Patients before, during, and after Sedation for Diagnostic and Therapeutic Procedures: Update 2016. Pediatrics. 2016; 138: e20161212.
 Green SM, Leroy PL, Roback MG, Irwin MG, Andolfatto G, Babl FE, et al. An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children. Anaesthesia. 2020; 75: 374–385.
 Gagey A, De Queiroz Siqueira M, Monard C, Combet S, Cogniat B, Desgranges F, et al. The effect of pre-operative gastric ultrasound examination on the choice of general anaesthetic induction technique for non-elective paediatric surgery. A prospective cohort study. Anaesthesia. 2018; 73: 304–312.
 Leviter J, Steele DW, Constantine E, Linakis JG, Amanullah S. “Full Stomach” despite the Wait: Point‐of‐care Gastric Ultrasound at the Time of Procedural Sedation in the Pediatric Emergency Department. Academic Emergency Medicine. 2019; 26: 752–760.
 Moake MM, Presley BC, Hill JG, Wolf BJ, Kane ID, Busch CE, et al. Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emer-gency Department Procedural Sedation Patients. Pediatric Emergency Care. 2020. (in press)
 Bouvet L, Desgranges F, Aubergy C, Boselli E, Dupont G, Allaouchiche B, et al. Prevalence and factors predictive of full stomach in elective and emergency surgical patients: a prospective cohort study. British Journal of Anaesthesia. 2017; 118: 372–379.
 Perlas A, Chan VS, Lupu C, Mitsakakis N, Hanbidge A. Ultrasound Assessment of Gastric Content and Volume. Anesthesiology. 2009; 111: 82–89.
 Perlas A, Mitsakakis N, Liu L, Cino M, Haldipur N, Davis L, et al. Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesthesia & Analgesia. 2013; 116: 357–363.
 Cubillos J, Tse C, Chan VWS, Perlas A. Bedside ultrasound assessment of gastric content: an observational study. Canadian Journal of Anaesthesia. 2012; 59: 416–423.
 Perlas A, Arzola C, Van de Putte P. Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review. Canadian Journal of Anaesthesia. 2018; 65: 437–448.
 Fukunaga C, Sugita M, Yamamoto T. Validity of ultrasonographic measurement of gastric volume in fasted pediatric patients without sedation. Journal of Anesthesia. 2016; 30: 900–903.
 Schmitz A, Schmidt AR, Buehler PK, Schraner T, Frühauf M, Weiss M, et al. Gastric ultrasound as a preoperative bedside test for residual gastric contents volume in children. Paediatric Anaesthesia. 2016; 26: 1157–1164.
 Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. British Journal of Anaesthesia. 2014; 113: 12–22.
 Spencer AO, Walker AM, Yeung AK, Lardner DR, Yee K, Mulvey JM, et al. Ultrasound assessment of gastric volume in the fasted pediatric patient undergoing upper gastrointestinal endoscopy: development of a predictive model using endoscopically suctioned volumes. Paediatric Anaesthesia. 2015; 25: 301–308.
 Cook-Sather SD, Liacouras CA, Previte JP, Markakis DA, Schreiner MS. Gastric fluid measurement by blind aspiration in paediatric patients: a gastroscopic evaluation. Canadian Journal of Anaesthesia. 1997; 44: 168–172.
 Cook-Sather SD, Tulloch HV, Liacouras CA, Schreiner MS. Gastric fluid volume in infants for pyloromyotomy. Canadian Journal of Anaesthesia. 1997; 44: 278–283.
 Bouvet L, Bellier N, Gagey-Riegel A, Desgranges F, Chassard D, De Queiroz Siqueira M. Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients: a prospective cohort study. Paediatric Anaesthesia. 2018; 28: 906–913.
 Desgranges F, Gagey Riegel A, Aubergy C, De Queiroz Siqueira M,
Chassard D, Bouvet L. Ultrasound assessment of gastric contents in children undergoing elective ear, nose and throat surgery: a prospective cohort study. Anaesthesia. 2017; 72: 1351–1356.
 Simpson KH, Stakes AF. Effect of anxiety on gastric emptying in preoperative patients. British Journal of Anaesthesia. 1987; 59: 540–544.
 Jolliffe DM. Practical gastric physiology. Continuing Education in Anaesthesia Critical Care & Pain. 2009; 9: 173–177.
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