The Rate of Full and Empty Stomach in Elective and Emergency Pediatric Patients
The Rate of Full and Empty Stomach in Elective and Emergency Pediatric Patients
Background and Aim:

 Pulmonary aspiration of gastric content in the perioperative period is rare, but it is an
 important cause of morbidity and mortality that anesthetists never want to encounter. Due to
 reasons such as emergency surgical procedures, communication problems with pediatric patients
 or their parents, impaired cognitive function, obesity, diabetes mellitus, chronic liver and
 kidney diseases, it is observed that there is sometimes inconsistency between the periods
 defined in the preoperative fasting guidelines in pediatric patients and the state of gastric
 content and volume encountered in clinical practice. There is a lack of data on children on
 this issue. In this study, primary we aimed to evaluate the incidence of empty and full
 stomach in pediatric patients who underwent elective and emergency surgery in our routine
 anesthesia practice. Also we want to determine the relationship between fasting time and
 qualitative assessment of gastric content. Secondary this study sought to examine whether
 correlation between gastric ultrasound finding and fasting time, and also to determine
 relationship with the current comorbidities.

 Design:

 This is a prospective, single blinded, observational study. The minimum sample size required
 to determine the prevalence of full stomach, 0.05, within the limits of ± 0.025 with 0.95
 confidence, was calculated as 292.

 When calculating with the proposed equation of n = 100 + 50i to determine the factors
 affecting by logistic regression (here i is the number of variables in the model), the
 minimum number of samples required for logistic regression analysis was calculated as 300 in
 case of 4 independent variables in the model. n=100+50*4= 300

 Methods:

 Pediatric patients younger than 18 yr old who are to undergo elective and emergency surgery
 under general anaesthesia at our hospital are enrolled in this prospective observational
 study between April and December 2021. Preoperative ultrasound examination of the gastric
 antrum are performed by one anesthesiologist who has been instructed and supervised by an
 experienced pediatric radiologist and who is blind to the patient's history. Ultrasonographic
 measurement of the gastric antral cross-sectional area (CSA) are performed in supine position
 and right lateral decubitus position (RLD). The gastric antrum is imaged in a sagittal plane,
 between the left lobe of the liver and the pancreas, at the level of the aorta, as previously
 described [1]. This examination allowed qualitative assessment of gastric contents according
 to the three-point grading scale previously described by Perlas and colleagues[2]. Grade 0
 was defined by the absence of appearance of any content in a flat antrum in both the supine
 and the RLD positions. Grade 1 was defined by the appearance of any gastric content in the
 RLD position only, and Grade 2 was defined by the appearance of any content in both the RLD
 and the supine positions. The antral cross-sectional area is also calculated in both
 position, by measuring the longitudinal diameter (D1) and the anteroposterior diameter (D2)
 of the antrum, from serosa to serosa using this formula [3] Antral area= (π x D1 X D2) / 4.
 Patients' characteristic data ( age, gender, weight, height, BMI and ASA physical status
 classification), fasting duration, type of elective and emergency surgery, chronic disease
 and complications (regurgitation, pulmonary aspiration, etc.) that may develop during the
 peroperative period are recorded.
Inclusion Criteria:

 -  Pediatric patients younger than 18 yr old who are to undergo elective and emergency
 surgery under general anaesthesia are included in the study.

 Exclusion Criteria:

 -  Exclusion criteria will be, having a nasogastric tube inserted and patient refusal.