Gastric contents in children presenting for upper endoscopy.
Previous studies of gastric contents in children presenting for surgery specifically excluded those with gastrointestinal disorders. Because these children often need sedation or anesthesia for procedures such as upper endoscopy, it is important to determine the gastric fluid volume and pH in this group to better characterize their risk of aspiration. We therefore analyzed the gastric fluid volume and pH of children with a variety of gastrointestinal symptoms presenting for upper endoscopy. After obtaining institutional review board approval, the stomach contents of 248 children (aged 2 mo to 18 yr) presenting for upper endoscopy were prospectively measured under direct endoscopic vision. Children were fasted for both solids and liquids for at least 6 h (<6 mo) or 8 h (>6 mo). Gastric fluid pH was measured using pH paper. Children received either deep sedation or general anesthesia and were grouped according to their presenting diagnosis. Results were analyzed by using analysis of variance, Kruskal-Wallis, and correlation (P value < 0.05). The mean gastric fluid volume was 0.35 +/- 0.45 mL/kg (range 0-3.14 mL/kg), and the mean gastric fluid pH was 1.37 +/- 1.6 (range 1-7). Of the children, 33% had gastric fluid volumes >0.4 mL/kg, 87% had gastric fluid pH <2.5, and 30% had gastric fluid volume >0.4 mL/kg and pH <2.5. Children with the presenting complaint of abdominal pain had the largest gastric fluid volumes. These data are not appreciably different from historical controls (healthy children fasted for an equivalent period of time who did not have gastrointestinal symptoms).


CONCLUSIONS
When fasted for at least 6-8 h, children with a history of gastrointestinal symptoms presenting for upper endoscopy did not have gastric contents with increased volume and acidity compared with previously published groups of children without gastric symptoms who were fasted the same length of time. These results do not support the argument that children with gastrointestinal symptoms pose an increased anesthetic risk for aspiration.
Department of Anesthesiology, Baystate Medical Center Children's Hospital, Springfield, Massachusetts 01199, USA.
D A
DA
Schwartz
N R
NR
Connelly
C A
CA
Theroux
C S
CS
Gibson
D N
DN
Ostrom
S M
SM
Dunn
B Z
BZ
Hirsch
A G
AG
Angelides
D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D004935:Esophageal Diseases / Q000503:physiopathology; D005215:Fasting; D005260:Female; D005745:Gastric Acidity Determination; D005766:Gastrointestinal Contents; D005767:Gastrointestinal Diseases / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D011015:Pneumonia, Aspiration / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D013270:Stomach