GASTRIC RESIDUAL VOLUME BEFORE ELECTIVE SURGERY IN CHILDREN DEPENDING ON PREOPERATIVE FASTING DURATION: SINGLE-CENTER PROSPECTIVE RANDOMIZED CLINICAL TRIAL

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.前言。保障择期手术前患者的舒适度并消除过度的术前限制，是现代术后快速康复理念的核心基础。 研究目的：基于超声检查，评估胃残余容量随术前禁食时长及清流质摄入情况的变化。 材料与方法。研究设计：单中心前瞻性随机临床试验。共纳入38名年龄6至17岁的择期手术患儿，按随机原则分为试验组（I组）与对照组（II组）。试验组（n=18）患儿于术前12小时起完全禁食禁饮；对照组（n=17）患儿可于术前2小时摄入剂量为4ml/kg的清水。纳入标准：a）年龄18岁以下的健康儿童；b）美国麻醉医师协会（ASA）I-II级功能状态评估；c）拟行外科手术干预；d）自愿签署知情同意书参与本研究。采用超声检查，分别取仰卧位与右侧卧位，测量胃窦横截面积，并据此计算胃内容物体积。采用视觉模拟评分法评估口渴严重程度，分为3个等级：0~3分为轻度口渴；4~6分为中度口渴；7~10分为重度口渴。 结果。本研究纳入的所有患儿均未发生麻醉及手术相关并发症，其中包括胃内容物误吸。试验组患儿的血糖中位数为4.5（4.2~4.6）mmol/L，显著高于对照组的4.1（3.9~4.5）mmol/L（p=0.014）。术前12小时禁食固体食物及清流质的患儿，其胃残余容量中位数为0.34（0.28~0.39）ml/kg，与术前2小时允许摄入4ml/kg清水的对照组患儿的0.36（0.31~0.4）ml/kg相比，差异无统计学意义（p=0.766）。试验组患儿的口渴强度中位数为3（3~4.75）分，对照组为1（0~1.5）分，差异具有统计学意义（p=0.000）。 结论。术前2小时摄入4ml/kg清水，可作为长时间术前禁食的安全替代方案，在提升患者舒适度的同时，不会增加胃内容物误吸的风险。