Perioperative Complication
Conditions
Keywords
Preoperative fasting, Anaesthesia, Children, breast-feeding
Brief summary
In the new guideline from ESAIC breast-feeding should be encouraged until 3 hours before anesthesia. This recommendation was based mainly on gastric emptying studies in neonates with small sample sizes and single center experience.To address the lack of high quality evidence for this recommendation, the ESAIC task force for preoperative fasting plans perform a multicenter RCT omparing 4 vs 3 hours of preoperative fasting for breast milk. The aim of the present pilot-study is to provide data for sample size calculation and feasibility for the multicenter trial.
Detailed description
Since the publication of several studies indicating that many children are subjected to unnecessarily long fasting waiting for surgery, there is great interest within the pediatric anesthesia community to understand gastric emptying to be able to revise existing guidelines. The new recommendation from ESAIC is that breast-feeding should be encouraged until 3 hours before anesthesia. This recommendation was based mainly on gastric emptying studies in neonates with small sample sizes and single center experience.To address the lack of high quality evidence for this recommendation, the task force plans to perform a multicenter RCT comparing 4 vs 3 hours of preoperative fasting for breast milk. Twenty infants scheduled for elective surgery or procedures requiring general anesthesia or sedation will be recruited for this randomized controlled pilot study. Based on the randomization, they are then asked to breast-feed (or bottle-feed with breast-milk) the child at 4 or 3 hours before the scheduled anesthesia induction. On arrival to the operating room, the gastric ultrasound examination will be performed for analysis of the gastric antrum CSA. After i.v. or inhalational anesthesia, an oro-gastric catheter will be inserted and any residual gastric contents are aspirated when rotating the infant from supine to semi-prone right and left positions. The volume and color of the aspirate will be recorded. The aim of the present pilot-study is to provide data for sample size calculation and feasibility for the multicenter trial.
Interventions
OTHER3 hours of preoperative fasting for breast milk
3 hours of preoperative fasting for breast milk
OTHER4 hours of preoperative fasting for breast milk
4 hours of preoperative fasting for breast milk
Sponsors
Uppsala University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Computerized randomization,
Intervention model description
Prospective randomized controlled pilot study
Eligibility
Sex/Gender
ALL
Age
0 Years to 24 Months
Healthy volunteers
No
Inclusion criteria
\- Breast-feeding infanta scheduled for elective procedure requiring general anesthesia
Exclusion criteria
* infant that does not breast-feed or is bottle-fed breast-milk * Moderate to severe gastrointestinal motility disorder. * Emergency surgery. * Age \> 24 months or age \< 37 gestational weeks * parents incapable of understanding the consent information due to language barrier
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| CSA | From arrival in the operating room until induction of anesthesia | Gastric antrum CSA (The antral cross-sectional area) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Aspirated volume | intraoperative | Aspirated volume |
Countries
Sweden
Outcome results
None listed