“Full Stomach” Despite the Wait: Point‐of‐care Gastric Ultrasound at the Time of Procedural Sedation in the Pediatric Emergency Department

• Published in: Academic emergency medicine Vol. 26; no. 7; pp. 752 - 760
• Main Authors: Leviter, Julie, Steele, Dale W., Constantine, Erika, Linakis, James G., Amanullah, Siraj, Macy, Michelle L.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2019
• Subjects: Anesthesia; Anesthesiology - methods; Child; Child, Preschool; Emergency medical care; Emergency Service, Hospital; Fasting; Female; Gastrointestinal Contents - diagnostic imaging; Humans; Male; Pediatrics; Point of care testing; Point-of-Care Systems; Preoperative Period; Prospective Studies; Pyloric Antrum - diagnostic imaging; Risk Assessment; Stomach; Time Factors; Ultrasonic imaging; Ultrasonography - methods; United States > US
• ISSN: 1069-6563; 1553-2712; 1553-2712
• DOI: 10.1111/acem.13651

Objectives The objective was to use gastric point‐of‐care ultrasound (POCUS) to assess gastric contents and volume, summarize the prevalence of “full stomach,” and explore the relationship between fasting time and gastric contents at the time of procedural sedation. Methods This was a prospective study of patients aged 2 to 17 years fasting prior to procedural sedation. A single sonographer scanned each patient's gastric antrum in two positions: supine with the upper body elevated and right lateral decubitus (RLD). Gastric content (empty, liquid, or solid) was noted, and the gastric volume (mL/kg) was estimated from antral cross‐sectional area (CSA). “Full stomach” was defined as any solid content or >1.2 mL/kg of liquid gastric content. Results We enrolled 116 subjects, with a median fasting time of 5.8 hours. Of the 107 with evaluable images, 74 patients, 69% (95% confidence interval [CI] = 60%–77%), were categorized as having a full stomach. Each hour of fasting was associated with lower odds (odds ratio = 0.79, 95% CI = 0.65–0) of a full stomach. However, the knowledge of fasting time alone provides little ability to discriminate between risk groups (C‐index = 0.66). Conclusions Gastric POCUS classified many patients as having a full stomach at the time of expected procedural sedation, despite prolonged fasting times. These findings may inform risk–benefit considerations when planning the timing and medication choice for procedural sedation.