GASTRIC RESIDUAL VOLUME BEFORE ELECTIVE SURGERY IN CHILDREN DEPENDING ON PREOPERATIVE FASTING DURATION: SINGLE-CENTER PROSPECTIVE RANDOMIZED CLINICAL TRIAL
Description
INTRODUCTION. Ensuring patient comfort and eliminating excess limitations before elective surgeries is the foundation of the modern concept of rapid patient recovery after surgeries. STUDY OBJECTIVE: Based on ultrasound examination, evaluate the residual volume of the stomach depending on the duration of preoperative fasting and intake of clear fluid. MATERIALS AND METHODS. Design – a single-center prospective randomized clinical trial. Examined 38 children aged 6 to 17 years before elective surgeries, who were randomly assigned to the main (I) and control (II) groups. In group I (n = 18), as early as 12 hours before the operation, children did not receive any food and fluid by mouth, in group II (n = 17), fresh water consumption in the amount of 4 ml/kg was allowed 2 hours before the operation. Inclusion criteria: a) healthy children under the age of 18; b) ASA I-II functional status assessment; c) planned surgical intervention; d) informed voluntary consent to participate in the study. Ultrasound examination was carried out in the supine position and on the right side with measurement of the cross-sectional area of the antrum of the stomach and subsequent calculation of the volume of gastric contents. To assess the severity of thirst, a visual analog scale was used, three levels were distinguished: 0-3 - light; 4-6 points - moderate; 7-10 points - strong thirst. RESULTS. No complications of anesthesia and surgery, including aspiration of gastric contents, were reported in any child included in the study. In children of group 1, the median glucose level was 4.5 (4.2-4.6) mmol/L, which was significantly higher than in patients of group II 4.1 (3.9-4.5) (p = 0.014). The median residual gastric volume in patients who did not receive solid food and clear fluid in the 12 hours before surgery was 0.34 (0.28 - 0.39) mL/kg, which was not statistically significantly different from the group of children who were allowed to drink fluid in the volume of 4 mL/kg in the 2 hours before surgery: 0.36 (0.31 - 0.4) mL/kg (p = 0,766). Thirst intensity in children of the first group was 3 (3-4.75) points, versus 1 (0-1.5) points in children of the second group (p = 0.000). CONCLUSIONS. Drinking 4 ml/kg of fresh water two hours before surgery is a safe alternative to prolonged fasting, providing patient comfort without increasing the risk of aspiration of gastric contents.