Preoperative gastric volume assessment using ultrasound in cerebral palsy pediatric patients: a prospective observational study
Avaliação pré-operatória do volume gástrico por ultrassonografia em pacientes pediátricos com paralisia cerebral: um estudo observacional prospectivo
Jiwon Han, Hyo-Seok Na, Seihee Min, Hyun-Jung Shin
Abstract
Background
Although cerebral palsy is a risk factor for aspiration, there is insufficient research on residual gastric volume after preoperative fasting in children with cerebral palsy. We evaluated the incidence of a full stomach by ultrasound assessment of the gastric volume in children with cerebral palsy who underwent orthopedic surgery after preoperative fasting.
Methods
The patients fasted for 8 h for solid foods and 2 h for clear liquids. We obtained the gastric antral cross-sectional area using ultrasound in the semi-recumbent and right lateral decubitus positions. A calculated stomach volume > 1.5 mL.kg−1 was considered as full, which poses a high aspiration risk. The primary outcome was the incidence of full stomach, and the secondary outcomes were the qualitative gastric volume, correlation of disease severity categorized according to the Gross Motor Function Classification System with the residual gastric volume, gastric volume per body weight, and qualitative gastric volume.
Results
Thirty-seven pediatric patients with cerebral palsy, scheduled for elective orthopedic surgery, were included for analysis. Full-stomach status was observed in none, and the gastric volume per body weight was 0.5 (0.4–0.7) mL.kg−1. No significant differences were observed in the residual gastric volume (p = 0.114), gastric volume per body weight (p = 0.117), or qualitative grade of gastric volume (p = 0.642) in relation to disease severities.
Conclusion
Children with cerebral palsy who fasted preoperatively had empty or nearly empty stomachs. Further studies are required to determine the optimal fasting duration for such children.
Keywords
Resumo
Introdução
Embora a paralisia cerebral seja um fator de risco para aspiração, não há pesquisas suficientes sobre o volume gástrico residual após jejum pré-operatório em crianças com paralisia cerebral. Avaliamos a incidência de estômago cheio pela avaliação ultrassonográfica do volume gástrico em crianças com paralisia cerebral submetidas a cirurgia ortopédica após jejum pré-operatório.
Métodos
Os pacientes jejuaram por 8 horas para alimentos sólidos e 2 horas para líquidos claros. Obtivemos a área transversal do antro gástrico por meio da ultrassonografia nas posições semirreclinada e decúbito lateral direito. Um volume gástrico calculado > 1,5 mL/kg foi considerado cheio, o que representa alto risco de aspiração. O desfecho primário foi a incidência de estômago cheio, e os desfechos secundários foram o volume gástrico qualitativo e a correlação da gravidade da doença categorizada de acordo com o Sistema de Classificação da Função Motora Grossa com o volume gástrico residual, volume gástrico por peso corporal e volume gástrico qualitativo.
Resultados
Trinta e sete pacientes pediátricos com paralisia cerebral, agendados para cirurgia ortopédica eletiva, foram incluídos para análise. O estado de estômago cheio não foi observado em nenhum deles, e o volume gástrico por peso corporal foi de 0,5 (0,4–0,7) mL/kg. Não foram observadas diferenças significativas no volume gástrico residual (p = 0,114), volume gástrico por peso corporal (p = 0,117) ou grau qualitativo do volume gástrico (p = 0,642) em relação à gravidade da doença.
Conclusão
Crianças com paralisia cerebral que jejuaram no pré-operatório apresentaram estômago vazio ou quase vazio. Mais estudos são necessários para determinar a duração ideal do jejum para essas crianças.
Palavras-chave
References
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Submitted date:
11/09/2023
Accepted date:
07/08/2024
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