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Ali M, Uslu A, Bodin L, Andersson H, Modiri AR, Frykholm P. Effects of caloric and nutrient content of oral fluids on gastric emptying in volunteers: a randomised crossover study. Br J Anaesth 2024; 132:260-266. [PMID: 38008651 DOI: 10.1016/j.bja.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Previous studies demonstrated conflicting results regarding the determinants of gastric emptying for fluids. Our aim was to compare gastric emptying times of fluids with different caloric and nutrient content. METHODS Healthy adult volunteers underwent gastric ultrasound assessment for 4 h after consuming beverages with different caloric and nutrient content using a crossover design (oat drink with 3% fat [310 kcal], mango juice [310 kcal], oat drink with 0.5% fat [185 kcal], and blackcurrant juice [175 kcal]). Gastric emptying time, gastric content volume, and the area under the curve (AUC) of gastric content volume-time profiles were calculated. RESULTS Eight females and eight males completed the study protocol. The mean (sd) gastric emptying times were 89 (32) min for blackcurrant juice, 127 (54) min for oat drink with 0.5% fat, 135 (36) min for mango juice, and 152 (40) min for oat drink with 3% fat. Gastric emptying times were slower for oat drink with 3% fat (P=0.007) and mango juice (P=0.025) than for blackcurrant juice. At 1 h after ingestion, gastric content volume was greater for mango juice (P=0.021) and oat drink with 3% fat (P=0.003) than for blackcurrant juice. The AUC was greater for oat drink with 3% fat than mango juice (P=0.029), oat drink with 0.5% fat (P=0.004), and blackcurrant juice (P=0.002), and for mango juice than blackcurrant juice (P=0.019). CONCLUSIONS Caloric and nutrient content significantly affected gastric emptying times. A high-calorie fruit juice (mango) exhibited delayed emptying times compared with a low-calorie fruit juice (blackcurrant). CLINICAL TRIAL REGISTRATION ISRCTN17147574.
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Affiliation(s)
- Mustafa Ali
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Ahmed Uslu
- Department of Anaesthesia and Intensive Care, Başkent University Ankara Hospital, Ankara, Turkey
| | - Lars Bodin
- Uppsala University Hospital, Uppsala, Sweden
| | - Hanna Andersson
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Ali-Reza Modiri
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Peter Frykholm
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
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Valencia A, Trujillo A, Arango F. Preoperative ultrasound evaluation of gastric contents in children one hour after ingestion of clear liquid: An observational study. Saudi J Anaesth 2023; 17:368-372. [PMID: 37601499 PMCID: PMC10435782 DOI: 10.4103/sja.sja_31_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 08/22/2023] Open
Abstract
Background Gastric ultrasound is an effective, non-invasive method to assess the nature and volume of gastric content in the pediatric population. Recently, the UK, European, and French Pediatric Anesthesia Societies recommend fast for clear fluids in children for 1 h. However, studies showing that 1 h of fasting is safe in the pediatric population are still scarce. This study aims to verify by ultrasound evaluation if 1 h of fasting for clear liquids is sufficient to have an empty stomach before anesthetic induction. Methodology Patients between 11 months and 16 years of age scheduled for elective outpatient surgery were included. A qualitative and quantitative ultrasound evaluation was performed by calculating the cross-sectional area (CSA) of the gastric antrum, 1 h after ingesting a volume of 3 mL/kg of a non-carbonated sports drink, before anesthetic induction. Results Fifty patients were included. The average CSA measured by ultrasound was 2.85 ± 1.64 cm2 with an average calculated total volume of 12.9 ± 11.06 mL. All patients had an empty stomach criterion (calculated volume ≤1.5 mL/kg) during the ultrasound evaluation, with an average of 0.40 ± 0.23 mL/kg. With the qualitative assessment of gastric volume, 19 patients (38%) were classified as grade 0, 31 patients (62%) as grade 1, and none as grade 2. Conclusion One hour of fasting after ingestion of 3 mL/kg of a non-carbonated sports drink is sufficient to meet ultrasound criteria for an empty stomach in a pediatric population undergoing elective outpatient surgery.
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Affiliation(s)
- Alejandra Valencia
- Departamento Quirúrgico, Facultad de Ciencias para la Salud, Universidad de Caldas, Caldas, Colombia
| | - Alexander Trujillo
- Departamento Quirúrgico, Facultad de Ciencias para la Salud, Universidad de Caldas, Caldas, Colombia
- Facultad de Ciencias de la Salud, Universidad de Manizales, Manizales, Colombia
- Doctorado de Ciencias de la Salud, Universidad de Caldas, Caldas, Colombia
| | - Fernando Arango
- Facultad de Ciencias de la Salud, Universidad de Manizales, Manizales, Colombia
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Eaddy N, Watene C. Perioperative management of fluids and electrolytes in children. BJA Educ 2023; 23:273-278. [PMID: 37389277 PMCID: PMC10300462 DOI: 10.1016/j.bjae.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 03/28/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- N. Eaddy
- Waikato Hospital, Hamilton, New Zealand
| | - C. Watene
- Waikato Hospital, Hamilton, New Zealand
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Aschkenasy G, Leder O, Pardes R, Nir EA, Shteyer E, Orlanski-Meyer E, Turner D, Gozal Y. Preoperative clear fluid fasting and endoscopy-measured gastric fluid volume in children. Paediatr Anaesth 2023. [PMID: 36916832 DOI: 10.1111/pan.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND In light of new recommendations to shorten clear fluid fasting time before anesthesia, our study aimed at exploring residual fluid volume in the stomach after different fasting times. We intended to perform direct endoscopic aspiration of stomach contents under vision, as part of routine gastroscopy assessment. Hereby we would be able to quantify true residual gastric fluid volume and acidity in children and measure their correlation with fasting times. METHODS The study was performed as a single-center, prospective study in pediatric perioperative day care at a university-affiliated tertiary care center. Aspiration of gastric fluid contents was performed in anesthetized children aged 1-18 years undergoing an elective gastroscopy. Recorded data included patient fast time, last meal content, last clear fluid content, and aspirated gastric volume and pH, as well as patient characteristics. RESULTS We included 253 gastroscopies, performed in 245 children. Mean fasting time for clear fluids was 6.9 h (range 1 h 40 min - 18 h 35 min) (SD 4.5). Mean age was 9.8 years (SD 5.1) and mean body weight was 33.2 kg (SD 18.7). Mean residual gastric volume was 12 mL (0-90) (SD 13.5) or 0.34 mL/kg (SD 0.37) and mean pH was 1.5 (SD 0.9). No significant correlation was observed between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight (r = -.103, p = .1), nor between clear fluid fasting time and the pH of the residual gastric fluid (r = -.07, p = .3). In more than half of the patients the residual gastric volume was less than 10 mL, unrelated to fasting time. CONCLUSIONS In children undergoing gastroscopy, we could not demonstrate any association between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight. Since we did not see a clinically relevant association between clear fluids fasting time and gastric residual volume, this study may support the recommendation to shorten clear fluids fasting time.
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Affiliation(s)
- Gabriella Aschkenasy
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Oren Leder
- Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Rivka Pardes
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eshel A Nir
- Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
| | - Eyal Shteyer
- Pediatric Liver Unit, Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Esther Orlanski-Meyer
- Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Dan Turner
- Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yaacov Gozal
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel
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Korkusuz M, Basaran B, Et T, Bilge A, Yarimoglu R, Osmanoglu UO. Gastric emptying times of obese and non-obese school-aged children after preoperative clear fluid intake: A prospective observational study. Paediatr Anaesth 2023. [PMID: 36876549 DOI: 10.1111/pan.14658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Liberal fasting regimens, which support clear fluid intake up to 1 h before surgery in children scheduled for elective surgery, are taking their place in guidelines. However, because of the lack of publications that investigate the gastric emptying time in preoperative obese children, the practice of 1-hour clear fluid fasting in obese children remained at the level of recommendation with weak evidence. AIMS The primary aim was to investigate whether there is a difference in gastric emptying times between obese and non- obese children after preoperative intake of 3 mL/kg clear liquid containing 5% dextrose by using ultrasound. METHODS A total of 70 children were included in the study in two groups, 35 obese and 35 non-obese, aged 6-14 years, who were scheduled for elective surgery. The baseline antral cross-sectional area measurements of the children in the groups were made using ultrasound. 3 mL/kg 5% dextrose was consumed. Ultrasound was repeated immediately after fluid intake and every 5 min until the antral cross-sectional area was at the baseline level. RESULTS The difference in median (IQR [range]) gastric emptying times (minutes) of non-obese {35 [30.0-45.0 (20-60)]} and obese children {35 [30.0-40.0 (25-60)]} were not statistically significant (median of differences 0.0, 95% CI -5.0 to 5.0; p = .563). The antral cross-sectional area and weight-adjusted gastric volumes returned to the baseline level within 60 min after the intake of clear liquid with 3 mL/kg 5% dextrose in all children in both groups. CONCLUSIONS Obese and non-obese children have similar gastric emptying times, and these groups can be offered clear fluids containing 3 mL/kg 5% dextrose 1 h before the surgery.
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Affiliation(s)
- Muhammet Korkusuz
- Department of Anaesthesiology and Reanimation, Karamanoglu Mehmetbey University, School of Medicine, Karaman, Turkey
| | - Betul Basaran
- Department of Anaesthesiology and Reanimation, Karamanoglu Mehmetbey University, School of Medicine, Karaman, Turkey
| | - Tayfun Et
- Department of Anaesthesiology and Reanimation, Karamanoglu Mehmetbey University, School of Medicine, Karaman, Turkey
| | - Aysegul Bilge
- Department of Anaesthesiology and Reanimation, Karamanoglu Mehmetbey University, School of Medicine, Karaman, Turkey
| | - Rafet Yarimoglu
- Department of Anaesthesiology and Reanimation, Karaman Training and Research Hospital, Karaman, Turkey
| | - Usame Omer Osmanoglu
- Department of Biostatistics, Karamanoglu Mehmetbey University, School of Medicine, Karaman, Turkey
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Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, Kuo CI, Soriano SG, Stricker PA, Tipton T, Grant MD, Marbella AM, Agarkar M, Blanck JF, Domino KB. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Anesthesiology 2023; 138:132-151. [PMID: 36629465 DOI: 10.1097/aln.0000000000004381] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.
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Odendaal P, Burke A, Coetzee J. Effect of a carbohydrṇate lollipop on the gastric volume of fasted pediatric patients. Paediatr Anaesth 2022; 32:1031-1037. [PMID: 35524771 PMCID: PMC9545620 DOI: 10.1111/pan.14479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Preoperative fasting is part of routine practice. Children subjected to prolonged preoperative fasting often suffer adverse effects. Consuming a preoperative lollipop may lessen their anxiety and have clinical benefits. AIMS To assess the effect of consuming a lollipop on gastric volume and the feasibility of administering a lollipop to a child preoperatively. METHODS In this prospective, repeated measures interventional study, we measured gastric antrum volume using ultrasound in children aged 2-18 years. We measured antrum volumes after participants had fasted for a minimum of 6 h for solids and 2 h for clear fluids. They then consumed a standard carbohydrate lollipop, and we repeated the antrum volume measurements after 1 h. RESULTS Of the 38 patients enrolled, 32 completed the study; four had ingested additional food or liquid, and two were diagnosed with systemic disease the day after data collection. The gastric volume data were normally distributed. The mean volume change was 0.01 ml kg-1 (95% CI -0.02 to 0.05; p = .460). The mean postlollipop volume was 0.51 ml kg-1 (95% CI 0.43 to 0.58). CONCLUSIONS Consuming a standard lollipop did not affect the gastric volume of fasted pediatric patients.
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Affiliation(s)
- Pieter Odendaal
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
| | - Annemie Burke
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
| | - Johan Coetzee
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
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New ESAIC fasting guidelines for clear fluids in children: Much ado about nothing or is it? Eur J Anaesthesiol 2022; 39:639-641. [PMID: 35822222 DOI: 10.1097/eja.0000000000001674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Valla FV, Tume LN, Jotterand Chaparro C, Arnold P, Alrayashi W, Morice C, Nabialek T, Rouchaud A, Cercueil E, Bouvet L. Gastric Point-of-Care Ultrasound in Acutely and Critically Ill Children (POCUS-ped): A Scoping Review. Front Pediatr 2022; 10:921863. [PMID: 35874585 PMCID: PMC9298849 DOI: 10.3389/fped.2022.921863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) use is increasing in pediatric clinical settings. However, gastric POCUS is rarely used, despite its potential value in optimizing the diagnosis and management in several clinical scenarios (i.e., assessing gastric emptying and gastric volume/content, gastric foreign bodies, confirming nasogastric tube placement, and hypertrophic pyloric stenosis). This review aimed to assess how gastric POCUS may be used in acute and critically ill children. Materials and Methods An international expert group was established, composed of pediatricians, pediatric intensivists, anesthesiologists, radiologists, nurses, and a methodologist. A scoping review was conducted with an aim to describe the use of gastric POCUS in pediatrics in acute and critical care settings. A literature search was conducted in three databases, to identify studies published between 1998 and 2022. Abstracts and relevant full texts were screened for eligibility, and data were extracted, according to the JBI methodology (Johanna Briggs Institute). Results A total of 70 studies were included. Most studies (n = 47; 67%) were conducted to assess gastric emptying and gastric volume/contents. The studies assessed gastric volume, the impact of different feed types (breast milk, fortifiers, and thickeners) and feed administration modes on gastric emptying, and gastric volume/content prior to sedation or anesthesia or during surgery. Other studies described the use of gastric POCUS in foreign body ingestion (n = 6), nasogastric tube placement (n = 5), hypertrophic pyloric stenosis (n = 8), and gastric insufflation during mechanical ventilatory support (n = 4). POCUS was performed by neonatologists, anesthesiologists, emergency department physicians, and surgeons. Their learning curve was rapid, and the accuracy was high when compared to that of the ultrasound performed by radiologists (RADUS) or other gold standards (e.g., endoscopy, radiography, and MRI). No study conducted in critically ill children was found apart from that in neonatal intensive care in preterms. Discussion Gastric POCUS appears useful and reliable in a variety of pediatric clinical settings. It may help optimize induction in emergency sedation/anesthesia, diagnose foreign bodies and hypertrophic pyloric stenosis, and assist in confirming nasogastric tube placement, avoiding delays in obtaining confirmatory examinations (RADUS, x-rays, etc.) and reducing radiation exposure. It may be useful in pediatric intensive care but requires further investigation.
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Affiliation(s)
- Frederic V. Valla
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lyvonne N. Tume
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | - Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Philip Arnold
- Department of Anaesthetics, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Walid Alrayashi
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Claire Morice
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Tomasz Nabialek
- Pediatric Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Aymeric Rouchaud
- Pediatric Radiology Department, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Eloise Cercueil
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bouvet
- Department of Anesthesiology and Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
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Saffer E, Nielsen DPD, Warwick E, Stilwell A, Webb C, Chow G, Place MK. Effect of pre-operative oral paracetamol on gastric residual volume and pH in young children in the context of a 1-hour clear fluid fast: a randomised controlled trial. Anaesthesia 2022; 77:449-455. [PMID: 35166373 DOI: 10.1111/anae.15670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
High gastric residual volume and low pH are associated with increased mortality following pulmonary aspiration in animal studies. The use of pre-operative oral paracetamol has not been investigated in younger children and infants in the context of a prescriptive 1-h clear fluid fast aimed at reducing the risk of pulmonary aspiration while improving patient experience. Children aged 1 month up to a weight of 25 kg and scheduled for elective surgery were randomly allocated to receive a prescribed 3.6 ml.kg-1 drink of water alone (water group) or 3 ml.kg-1 water and oral Infant Calpol® syrup (24 mg.ml-1 concentration, equivalent volume 0.6 ml.kg-1 , paracetamol group) 1 h before the induction of anaesthesia. Following induction, a nasogastric tube was used to aspirate gastric contents and the volume and pH were recorded. Ninety-seven children, median (IQR [range]) age 24 (12-45 [1-96]) months and weight 12.4 (9.7-16.0 [2.9-27.0]) kg, were analysed. Median time from drink to induction was 54 (45-60 [21-113]) min. There was no significant difference in gastric residual volume (p = 1) or pH (p = 0.99) between the water and the paracetamol groups. Sub-group analysis revealed no significant difference in gastric residual volume or pH for 29 children who weighed < 10 kg compared with > 10 kg. Using a prescriptive fluid regime of 3 ml.kg-1 of water, the addition of oral paracetamol syrup did not significantly alter gastric residual volume or pH in the context of a 1-h fast in infants and young children.
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Affiliation(s)
- E Saffer
- Department of Anaesthesia, King's College Hospital NHS Trust, London, UK
| | - D P D Nielsen
- Department of Anaesthesia, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - E Warwick
- Department of Anaesthesia, King's College Hospital NHS Trust, London, UK
| | - A Stilwell
- Department of Anaesthesia, King's College Hospital NHS Trust, London, UK
| | - C Webb
- Department of Anaesthesia, King's College Hospital NHS Trust, London, UK
| | - G Chow
- Department of Anaesthesia, King's College Hospital NHS Trust, London, UK
| | - M-K Place
- Department of Anaesthesia, King's College Hospital NHS Trust, London, UK
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