Ultrasound Assessment of Gastric Fluid Volume in Children Scheduled for Elective Surgery After Clear Fluid Fasting for 1 Versus 2 Hours: A Randomized Controlled Trial.

BACKGROUND: This study aimed to compare the gastric fluid volume (GFV) in children who fasted 1 versus 2 hours using ultrasound, after ingestion of a defined volume of clear fluid. METHODS: Children scheduled for elective surgery were enrolled in this randomized, double-blinded, controlled trial. After receiving 3 mL kg -1 clear fluid, participants were randomized to have a gastric ultrasound after fasting for either 1 hour (1-hour group, n = 116) or 2 hours (2-hour group, n = 111). Our primary outcome was the GFV. Other outcomes included the antral cross-sectional area, frequency of high risk and low risk of aspiration, and qualitative grading for the gastric antrum. RESULTS: Two hundred and twenty-seven children were available for final analysis. The median (Q1-Q3) GFV was higher in the 1-hour group versus the 2-hour group (0.61 [0.41-0.9] mL kg -1 vs 0.32 [0.23-0.47] mL kg -1 ; P value = .001). None of the study groups had GFV ≥1.5 mL kg -1 . The frequency (%) of GFV ≥1.25 mL kg -1 was comparable between both groups (2 [1.7%] vs 0 [0%], P value = .165). However, the frequency of GFV ≥0.8 mL kg -1 was higher in 1-hour group than in 2-hour group (34.5% vs 4.5%), and grade 2 antral grading score was 56.9% in 1-hour group vs 0.9% in 2-hour group ( P value <.001). CONCLUSIONS: In healthy children scheduled for elective surgery receiving 3 mL kg -1 clear fluid, the median GFV after 1-hour fasting was double the volume after conventional 2-hour fasting. These findings should be considered whether weighting the risk/benefit of a liberal approach to preoperative fasting versus the risk of pulmonary aspiration.

Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial.

BACKGROUND: Maternal hypotension is a common complication after spinal anesthesia for cesarean section (CS). In this study we investigated the role of leg elevation (LE) as a method for prevention of post-spinal hypotension (PSH) for cesarean section. METHODS: One hundred and fifty full term parturients scheduled for CS were included in the study. Patients were randomized into two groups: Group LE (leg elevation group, n = 75) and group C (Control group, n = 75). Spinal block was performed in sitting position after administration of 10 mL/Kg Ringer's lactate as fluid preload. After successful intrathecal injection of local anesthetic, Patients were positioned in the supine position. Leg elevation was performed for LE group directly after spinal anesthesia and maintained till skin incision. Intraoperative hemodynamic parameters (Arterial blood pressure and heart rate), intra-operative ephedrine consumption, incidence of PSH, and incidence of nausea and vomiting were reported. RESULTS: LE group showed lower incidence of PSH (34.7% Vs 58.7%, P = 0.005) compared to the control group. Arterial blood pressure was higher in the LE group compared to the control group in the first two readings after spinal block. Other readings showed comparable arterial blood pressure and heart rate values between both study groups; however, LE showed less ephedrine consumption (4.9 ± 7.8 mg Vs 10 ± 11 mg, P = 0.001). CONCLUSION: LE performed immediately after spinal block reduced the incidence of PSH in parturients undergoing CS. TRIAL REGISTRATION: The study was registered at Pan African Clinical Trials Registry system on 5/10/2015 with trial number PACTR201510001295348 .