INGESTION OF LIQUIDS COMPARED WITH PREOPERATIVE FASTING IN PEDIATRIC OUTPATIENTS

The preoperative fast is often an unpleasant preoperative experience that might be alleviated by allowing children to drink clear liquids. The authors compared gastric fluid volume and pH in two groups of children, one of whom was permitted clear liquids until 2 h before surgery (study group) and the other followed routine preoperative fasting orders (control group). The study group was not limited in the quantity of clear liquid allowed with the exception that the last intake prior to surgery was limited to 8 ounces. The study group (n = 53) averaged 5.9 ± 5 yr and weighed 23.6 ± 17 kg, while the control group averaged 7.3 ± 4.6 yr and weighed 29 ± 17.7 kg (P = NS). Gastric contents were aspirated following induction of anesthesia. Gastric fluid volume averaged 0.44 ± 0.51 ml/kg for study group and 0.57 ± 0.51 ml/kg in the control group (P = 0.12). Of the study patients, 48% had a measured gastric fluid volume ≥ 0.4 ml/kg compared with 58% of the control patients (P = 0.77). Eighty three patients had sufficient gastric fluid for pH determination; of these 34/35 (97%) in the study group and 44/48 (92%) in the control group had a gastric fluid pH ≤ 2.5. Using a linear analog scale parents rated the children in the study group to be less irritable (P < 0.001) and to have had a better overall preoperative experience (P < 0.01) compared with the control patients. The authors conclude that drinking clear liquids up to 2 h prior to the induction of anesthesia is unlikely to substantially effect the volume of gastric fluid contents or the percentage of patients with a gastric fluid pH ≤ 2.5. Although not diminishing the risk of aspiration, clear liquids appear to add no additional risk for aspiration of gastric contents in normal healthy children and may provide some psychological benefit as evidenced by a decrease in irritability prior to induction of anesthesia.