Sümpelmann Anne E, Sümpelmann Robert, Lorenz Michael, Eberwien Ilona, Dennhardt Nils, Boethig Dietmar, Russo Sebastian G
Department of Anesthesiology, University of Goettingen Medical Center, Goettingen, Germany.
Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
Paediatr Anaesth. 2017 Aug;27(8):816-820. doi: 10.1111/pan.13172. Epub 2017 Jul 4.
In current guidelines, 6 hours of fasting is recommended for solids to limit the risk of pulmonary aspiration during anesthesia in children. Ultrasonography has recently been introduced to evaluate gastric volumes in children in the context of preanesthetic fasting. Therefore, in this study, we firstly evaluated the precision of ultrasound assessment of gastric volume in an experimental setting and secondly studied gastric emptying times after a normal breakfast in healthy preschool children using ultrasound.
In a preliminary experiment, a pear-shaped elastic balloon was filled and emptied in 50 mL steps from 0 to 500 mL with water. After each step, the balloon antral area was measured using ultrasonography. Thereafter, gastric emptying was examined in healthy preschool children after normal breakfast by sonographic measurements of the gastric antral area in right lateral decubitus position at two consecutive timepoints. Correlation coefficients (Pearson, 95% CI) between the balloon antral area and the balloon volume or gastric antral area and fasting time were calculated and gastric emptying time was extrapolated by linear regression. Data are presented as mean (range).
In the balloon experiment, the balloon volume correlated significantly with the balloon antral area (63 measurements, r=.96, P<.0001, 95% CI 0.93 to 0.97). In the preschool child measurements, a total of 30 children (age 47 (36-66) months) were included. The gastric antral area correlated significantly with fasting time (r=-.69, P<.0001, 95% CI -0.8 to -0.51). The first gastric antral area after breakfast was significantly higher when compared to the second gastric antral area before lunch (10.4 ± 3.7 (1.7-17.8) vs 5.5 ± 2.6 (1.4-11.8) cm ; mean difference -5.04, 95% CI -6.3 to -3.8, P<.0001). The calculated mean gastric emptying time was 236 minutes.
The results of the balloon experiment showed a high correlation between balloon antral area and balloon volume. In the preschool child measurements, gastric antral area correlated with fasting time, and the mean gastric emptying time was lower than 4 hours after breakfast. These results support a more liberal perioperative fasting regimen after a light meal or breakfast in routine pediatric anesthesia.
在当前指南中，建议禁食固体食物6小时，以降低儿童麻醉期间发生肺误吸的风险。最近，超声检查已被用于在麻醉前禁食的背景下评估儿童的胃容量。因此，在本研究中，我们首先在实验环境中评估了超声评估胃容量的准确性，其次使用超声研究了健康学龄前儿童正常早餐后的胃排空时间。
在一项初步实验中，一个梨形弹性气球从0到500 mL以50 mL的步长用水填充和排空。每一步之后，使用超声测量气球的胃窦面积。此后，在健康学龄前儿童正常早餐后，通过在右侧卧位连续两个时间点超声测量胃窦面积来检查胃排空情况。计算气球胃窦面积与气球体积或胃窦面积与禁食时间之间的相关系数（Pearson，95%CI），并通过线性回归推断胃排空时间。数据以平均值（范围）表示。
在气球实验中，气球体积与气球胃窦面积显著相关（63次测量，r = 0.96，P < 0.0001，95%CI 0.93至0.97）。在学龄前儿童测量中，共纳入30名儿童（年龄47（36 - 66）个月）。胃窦面积与禁食时间显著相关（r = -0.69，P < 0.0001，95%CI -0.8至-0.51）。早餐后的第一个胃窦面积显著高于午餐前的第二个胃窦面积（10.4±3.7（1.7 - 17.8）vs 5.5±2.6（1.4 - 11.8）cm；平均差异 -5.04，95%CI -6.3至-3.8，P < 0.0001）。计算出的平均胃排空时间为236分钟。
气球实验结果显示气球胃窦面积与气球体积之间具有高度相关性。在学龄前儿童测量中，胃窦面积与禁食时间相关，早餐后平均胃排空时间低于4小时。这些结果支持在常规小儿麻醉中，在清淡饮食或早餐后采用更宽松的围手术期禁食方案。
