Effect of preoperative paracetamol on gastric volumes and pH in children.

The effect preoperative paracetamol elixir has on gastric contents is unknown. Children presenting for elective adenotonsillectomy were randomized to receive either paracetamol elixir (40 mg x kg(-1)) 90 min before surgery or paracetamol suppositories (40 mg x kg(-1)) intraoperatively. Following induction of anaesthesia a 16 Fr multiple-oriface orogastric tube was passed into the stomach and measure taken of the residual gastric volume and pH. The children had a mean age of 8.5 years (SD 3.2) with a weight of 35 kg (SD 16.5). Children given elixir (n=41) had a mean residual gastric volume of 0.083 ml x kg(-1) (95% CI; 0.006, 1.24) and a pH of 1.83 (95% CI; 0.75, 4.49), while those given suppositories (n=40) had a mean residual gastric volume of 0.083 ml x kg(-1)(95% CI; 0.008, 0.9) and a pH of 2.07 (95% CI; 0.84, 5.12). There was no significant difference between these two groups. Paracetamol elixir is rapidly absorbed in the gastrointestinal system of children and preoperative administration has no effect on gastric contents. Given paracetamol's slow equilibration rate constant from the central to the effect compartment, children may be given this medication preoperatively for routine surgical procedures.     

Omeprazole reduces preoperative gastric fluid acidity and volume in children

To explore the effects of oral omeprazole on preoperative gastric fluid pH and volume in children, 104 healthy in-patients aged 4–9 yr were randomly allocated to four groups (n = 26). Subjects in the Omeprazole-Omeprazole Group received two doses of omeprazole (20 mg per dose), those in the Placebo-Placebo Group, two doses of placebo, those in the Placebo-Omeprazole and Omeprazole-Placebo Groups, one dose each of the two preparations by mouth. For each treatment regimen, the first medication was administered at 9:00 p.m. on the night before surgery and the second at 5:30 a.m. on the morning of the day of surgery (three hours preoperatively). Children undergoing elective surgery were offered 10 nil · kg^?1 of apple juice three hours before induction of anaesthesia. After induction of anaesthesia and tracheal intubation, gastric fluid was aspirated through a large-bore, multiorifice orogastric tube and analyzed for pH and total fluid volume. The administration of omeprazole at bedtime before surgery increased gastric pH (3.3 ± 1.3 vs 2.0 ± 0.6, P < 0.05) in comparison with placebo, as did two doses of omeprazole (pH = 4.8 ± 1.6, P < 0.05). A single dose of omeprazole administration on the morning of the day of surgery failed to increase gastric pH. There was a reduction in the number of children with a pH < 2.5 and a volume > 0.4 ml · kg^?1 in the Omeprazole-Omeprazole and Omeprazole-Placebo Groups compared with the Placebo-Placebo or Placebo-Omeprazole Groups. Oral omeprazole 20 mg administered on the night prior to surgery will improve the gastric environment at the time of induction of anaesthesia, thus reducing the potential risk of pneumonitis, should the aspiration of gastric contents occur following the induction of anaesthesia. These data also suggest that this drug, when administered in a single dose of approximately 1.0 mg · kg^?1 three hours before surgery, is ineffective in increasing gastric fluid pH to > 2.4.     

Ranitidine suspension or famotidine resoriblette and gastric fluid volume and pH

We studied the effect of two new formulations of H₂-receptor antagonists on gastric fluid pH and volume. Forty-five healthy, elective adult in-patients in three study groups, 15 in each, were premedicated using oral diazepam 10 mg with 100 ml of a dose of water soluble suspension of ranitidine 300 mg with sodium citrate/bicarbonate, or a resoriblette of famotidine 40 mg, or placebo. Gastric fluid samples were obtained by blind aspiration after anaesthesia induction, 50–70 min from premedication, and again 90 min from premedication. After a mean period of 60 min from ingestion the patients medicated with H₂-antagonists had higher gastric juice pH than those in the control group (1.5 (1.1–6.3), median (range)) (P < 0.0001) for ranitidine (6.8 (4.1–7.8)), P< 0.01 for famotidine (3.9 (1.5–7.6)); P < 0.05 ranitidine vs famotidine). Recovered volumes were similar for the groups (median 3–4 ml, range 0–50 ml). None of the H₂ patients had pH < 3.5 and volume ≥0.3 ml · kg^?1 (P<0.05 vs placebo). In second aspirations, taken 90 min from premedication, the group differences from control in pH persisted. Famotidine patients had the lowest volumes (P < 0.05 vs controls); yet one famotidine patient had a pH < 2.5 and volume ≥ 0.3 ml · kg^?1. It is concluded that, at the moment of oral anxiolytic premedication, ranitidine-buffer suspension effectively reduced gastric juice acidity, whereas famotidine resoriblette failed to increase reliably gastric pH in 50–90 min.     

Lansoprazole reduces preoperative gastric fluid acidity and volume in children

The purpose of this study was to explore the efficacy of lansoprazole, a proton pump inhibitor, in reducing the acidity and volume of gastric aspirate in children immediately following the induction of anaesthesia. One hundred healthy in-patients aged 3–11 yr undergoing elective surgery were randomly allocated to four groups (n = 25 each): lansoprazole-lansoprazole, placebo-placebo, placebo-lansoprazole, and lansoprazole-placebo. For each treatment regimen, the first medication was administered at 9:00 pm on the night before surgery and the second at 5:30 am on the morning of the day of surgery (three hours preoperatively). The dose of lansoprazole was 30 mg (approximately 1.4 mg · kg^?1 mean). Children were offered 10 ml · kg^?1 apple juice three hours before induction of anaesthesia. After induction of anaesthesia and tracheal intubation, gastric fluid was aspirated through a large-bore, multiorifice orogastric tube and analyzed for pH and total fluid volume. Lansoprazole increased gastric fluid pH and decreased gastric fluid volume regardless of whether it was administered before or after placebo. Two consecutive doses of lansoprazole was the most effective means of increasing the pH and reducing the volume of gastric aspirate; in this group, there were no subjects with gastric aspirate volume >0.4 ml · kg^?1 and pH <2.5. Oral lansoprazole, at least 30 mg, given on the night before surgery or on the morning of surgery will improve the gastric environment at the time of induction of paediatric anaesthesia. The most effective regimen was two doses (at bedtime and on the morning) of lansoprazole.     

Gastric fluid volume and pH in scheduled surgical patients following unrestricted oral fluid intake until two hours before surgery

BACKGROUND: In scheduled surgery, drinking is generally restricted for 6-8 hours before operation to avoid aspiration pneumonia induced by aspiration of residual gastric contents. However, the restriction is hard for patients and also there is no evidence of reduction of such a risk. We examined the correlation between water intake and residual gastric content. METHODS: We studied 60 patients scheduled for gynecological operations (ASA 1 or 2). They were allowed to drink clear water freely until two hours before operation, and timing and volume of their drinking were recorded. In addition, volume and pH of the residual gastric content were measured at induction of anesthesia. RESULTS: The mean volumes of fluids they had are 157 ml (range 0-750 ml) in the morning, and 486 ml (range 80-1300 ml) in the afternoon. The patients took more water as the scheduled time of operation became nearer. There was no correlation between the volume of preoperative drinking with the volume and pH of gastric content. CONCLUSIONS: Intake of clear water until two hours before surgery has been shown to be safe and contribute to patients' satisfaction.     

Effect of oral liquids and ranitidine on gastric fluid volume and pH in children undergoing outpatient surgery

Eighty-eight children (mean age 5.6 yr, range 1-14 yr) about to undergo elective outpatient surgery were randomly assigned to four groups. All children were given phenolsulfonphthalein (PSP) orally 2-3 h before the scheduled time of surgery as a marker dye to assess gastric emptying. Immediately after receiving PSP they were given: group A--liquids, up to 5 ml/kg + placebo (glucose water 0.2 ml/kg); group B--liquids, up to 5 ml/kg + ranitidine 2 mg/kg in glucose water 0.2 ml/kg; group C--placebo only; group D--ranitidine only. Gastric contents were aspirated after induction of anesthesia. Mean volume (range) in ml/kg of aspirated gastric fluid in each group was: group A--0.34 (0-1.0); group B--0.17 (0.07); group C--0.25 (0-1.1); group D--0.16 (0-0.6). The pH mean (range) value was: group A--1.83 (0.9-3.6); group B--4.76 (2.0-7.7); group C--2.10 (1.2-4.1); group D--3.97 (1.3-7.3). PSP could not be detected in the gastric samples from children in whom the ingestion-sampling interval was more than 2.25 h. In comparison with prolonged starvation, administration of oral liquids without ranitidine 2-3 h preoperatively did not produce a significant increase in mean volume of gastric aspirate, and there was no increase in the number of patients with gastric aspirate greater than 0.4 ml/kg. Administration of ranitidine with or without fluids resulted in a decrease in both volume and acidity of gastric contents.     

Effects of oral cimetidine and ranitidine on gastric pH and residual volume in children

The effect of orally administered cimetidine 7.5 mg/kg (group 1), ranitidine 1.5 mg/kg (group 2), ranitidine 2.0 mg/kg (group 3), or a placebo (group 4) on gastric pH and gastric residual volume of 60 healthy children 2-6 yr of age admitted for elective surgery was evaluated. Both cimetidine and ranitidine administered 1-2 h prior to induction of anesthesia effectively increased the gastric pH:5,47 - 1.85 ml/kg (group 1), 4.92 +/- 2.1 ml/kg (group 2), 5.30 +/- 1.82 ml/kg (group 3) compared with 1.75 +/- 0.58 ml/kg (group 4) (P less than 0.001). A single dose of ranitidine 1.5 mg/kg was an effective as ranitidine 2.0 mg/kg and cimetidine 7.5 mg/kg. Neither drug decreased the gastric residual volume: 0.32 +/- 0.33 ml/kg (group 1), 0.31 +/- 0.06 ml/kg (group 2), 0.23 +/- 0.05 ml/kg (group 3), and 0.33 +/- 0.05 ml/kg (group 4). The combination of a volume greater than 0.4 ml/kg and a pH less than 2.5 was found in 33% (five of 15) of patients in the placebo group (group 4). In contrast, there were no patients with this combination in groups 1, 2, or 3 (P less than 0.001).     

Oral premedication with midazolam in paediatric anaesthesia. Effects on sedation and gastric contents

The aim of this study was to assess oral premedication with midazolam in paediatric anaesthesia. Sedation, quality of induction, recovery time, acceptance and effects on gastric contents were analysed. This prospective, double blind, at random and controlled study was performed in 107 children, aged between three and ten years. They were divided into: group 1 (control, n=29), group 2 (placebo) receiving 5 ml of water in the preoperative stage (n=40), and group 3 (midazolam) with 0.75 mg·kg^-1 midazolam by mouth (n=38). Two children refused to take medication. In children aged five years or more (n=48) of groups 2 and 3, acceptance of premedication was evaluated. The midazolam group showed a better level of sedation as compared with the placebo (P<0.05). The recovery time was similar for the two groups. There were no statistically significant differences in gastric pH or residual volume among the three groups. It is concluded that midazolam given by mouth is an efficient and safe drug for premedication in paediatric anaesthesia.     

Fluid deprivation before operation

The effect of oral fluids before operation, followed by intramuscular morphine, on gastric volume and pH was examined in 150 elective surgical patients, ASA physical status 1 and 2, who were randomly assigned to one of the three groups of 50 each. Group 1 (control) continued their overnight fast; patients in Groups 2 and 3 received 150 ml water 2 hours before the scheduled time of surgery. Patients in Group 3 received intramuscular morphine 0.15 mg/kg and promethazine 0.5 mg/kg one hour before operation. The residual gastric volume was obtained by suction and its volume and pH measured immediately after induction of anaesthesia. Statistically significant (p less than 0.05) decrease in residual gastric volume was observed in Groups 2 and 3 as compared to Group 1. However, the difference between these two groups was not statistically significant. There was no statistically significant difference in pH among the three groups. Overnight fluid fasting is not justified in elective surgical patients. Morphine can be safely given one hour before surgery in patients who have received water (150 ml) 2 hours before operation.     

Shortened preanesthetic fasting interval in pediatric cardiac surgical patients.

The recent liberalization of preoperative feeding orders in healthy pediatric outpatients prompts the question of whether this applies to children about to have cardiac surgery. The authors compared gastric fluid volume and pH in two groups of children undergoing elective cardiac surgery, one of which was not only permitted ad libitum clear liquids but was mandated to drink clear liquids 2-3 h before induction of anesthesia (study group). The other group followed routine inpatient preoperative fasting orders (control group). The study group (n = 44) averaged 3.1 +/- 4.1 yr and weighed 15.3 +/- 16.3 kg; the control group averaged 3.3 +/- 3.9 yr and weighed 14.3 +/- 12.1 kg (P = 0.82, 0.73, respectively). Aspiration of residual gastric fluid volume was attempted in all patients after induction of anesthesia. Gastric fluid volume averaged 0.6 +/- 0.9 mL/kg in the study group and 0.4 +/- 0.6 mL/kg in the control group (P = 0.13). Of the study patients, 41% had a measured gastric volume greater than or equal to 0.4 mL/kg compared with 32% of the control patients (P = 0.50). Of the 42 patients who had residual gastric fluid aspirated, pH determinations were completed on 37 aspirates; of these 19 of 20 (95%) in the study group and 14 of 17 (82%) in the control group had a gastric pH less than or equal to 2.5. Using a linear analogue scale, parents rated children in the study group to be more comfortable, less hungry, and less thirsty compared with the control patients (P = 0.004, 0.002, 0.0001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Oral bioavailability of clonidine in children

Background: Oral clonidine is used as premedication in children. The bioavailability of clonidine given orally in adults is 75–100% but is unknown in children. Methods: Children (3–10 years) undergoing adenotonsillectomy were administered oral clonidine 4 mcg·kg^?1 mixed with apple fruit drink as premedication. Intravenous plasma was assayed for clonidine concentration at 5, 15, 30, 45 min and 1, 2, 4, 6, 12, 18 h after administration. Clonidine plasma concentrations were determined by liquid chromatography‐mass spectroscopy, and pharmacokinetic parameters were calculated using nonlinear effects mixed‐effects models. Current data were pooled with published time–concentration profiles from children (n = 49) administered intravenous clonidine to determine oral bioavailability. Results: There were eight children studied (age 3–10 years, weight 10.5–36 kg). A two‐compartment model with first‐order absorption and elimination was used to describe time–concentration profiles. Population parameter estimates (CV%; 95% CI), standardized to a 70‐kg person, were absorption half‐life (Tabs), 0.45 (85.1; 0.221–0.884) h, absorption lag time (Tlag), 0.148 (91.2; 0.002–0.316) h, Clearance (CL) 17.9 (30.3; 16–20.3) l·h^?1 per 70 kg, between compartment clearance (Q) 121 (44.3; 80.1–165) l·h^?1 per 70 kg, central volume (V1) 81.2 (71.5; 60.7–105) l·70 kg^?1, peripheral volume of distribution (V2) 113 (33.9; 91–131) l·70 kg^?1. The oral bioavailability was 55.4% (CV 6.4%; 95% CI 0.469, 0.654). Conclusions: Clonidine administered with an apple fruit drink displays a variable and relatively slow absorption after oral administration (T_max 1.04 h, C_max 0.77 mcg·l^?1). The oral bioavailability was 55.4%, which is less than reported in adults. Consequently, higher oral doses of clonidine (per kg) are required when this formulation is used to achieve concentrations similar to those reported in adults.     

Effect of minimizing preoperative fasting on perioperative blood glucose homeostasis in children

Two hundred healthy, unpremedicated children, ages 1–10 years, scheduled for elective outpatient surgery were studied in order to examine the effect of minimizing preoperative fasting on perioperative blood glucose concentrations in paediatric patients. None of the patients ingested solids after midnight. On the day of surgery, the children were assigned to one of two groups. Group A children (n= 113) were not allowed any liquids for at least 6 h prior to surgery (NPO). Children in Group B (n= 87) ingested 10 ml·kg^?1 of apple juice 2–4 h prior to the induction of anaesthesia. All patients received lactated Ringer's solution intraoperatively, unless BG at induction was < 50 mg·dl^?1 (2.8 m·mol·l^?1) in which case dextrose 2.5% in lactated Ringer's solution was administered. None of the patients who received apple juice was hypoglycaemic during induction of anaesthesia. However, two children in the NPO group had blood glucose values ± 50 mg·dl^?1 (2.8 m·mol·l^?1) at the time of induction of anaesthesia. Thirteen (11%) patients in Group A and 6 (7%) patients in Group B showed either no change or a further decrease in their postoperative BG concentration as compared with their induction values. Two of 43 patients in Group A and 2 of 41 patients in Group B had gastric fluid volumes > 0.4 ml/kg. All patients in both groups had gastric pH < 2.5. This study shows that gastric fluid volume and pH following a 2–4 h fast are not different from the values measured in children who were subjected to a traditional fasting period of 6 h or longer. Moreover, apple juice consumed 2–4 h prior to surgery neither buffers gastric pH nor does it modify intraoperative glucose homeostasis in children.     

Efficacy,duration, and absorption of a paediatric oral liquid preparation of ranitidine hydrochloride

The objectives of this study were to assess the clinical efficacy of a new oral ranitidine liquid preparation in reducing gastric acidity and volume, to determine the degree of absorption of the drug, and to determine the duration of drug effect. Eighty preoperative children between the ages of one and six years were enrolled in each of three centres. Each subject was allocated to one of the following groups: Group A - apple juice, 5 ml.kg-1 plus placebo liquid; Group B - apple juice, 5 ml.kg-1 plus ranitidine hydrochloride 2 mg.kg-1; Group C - water, 5 ml and placebo liquid; or Group D - water, 5 ml and ranitidine liquid 2 mg.kg-1. All study agents were administered at least two hours before surgery along with a dye marker, sulfobromophthalein 1 ml (50 mg.ml-1). Following induction of anaesthesia, gastric fluid was aspirated, and analyzed for pH, volume, and sulfobromophthalein content (as an index of the ingested fluids). A serum sample was also drawn and analyzed for ranitidine content by high performance liquid chromatography. Groups B and D had fewer subjects with pH below 2.5 and gastric volume > 0.4 ml.kg-1. The duration of reduced volume and acidity was shown to be greatest from two to four hours after drug administration. Thirty-three percent of subjects receiving oral ranitidine, 2 mg.kg-1 hydrochloride as a single dose demonstrated no measurable effect on gastric pH and volume; 28 of those subjects had adequate ranitidine serum levels.     

Ingestion of liquids compared with preoperative fasting in pediatric outpatients

The preoperative fast is often an unpleasant preoperative experience that might be alleviated by allowing children to drink clear liquids. The authors compared gastric fluid volume and pH in two groups of children, one of whom was permitted clear liquids until 2 h before surgery (study group) and the other followed routine preoperative fasting orders (control group). The study group was not limited in the quantity of clear liquid allowed with the exception that the last intake prior to surgery was limited to 8 ounces. The study group (n = 53) averaged 5.9 +/- 5 yr and weighed 23.6 +/- 17 kg, while the control group averaged 7.3 +/- 4.6 yr and weighed 29 +/- 17.7 kg (P = NS). Gastric contents were aspirated following induction of anesthesia. Gastric fluid volume averaged 0.44 +/- 0.51 ml/kg for study group and 0.57 +/- 0.51 ml/kg in the control group (P = 0.12). Of the study patients, 48% had a measured gastric fluid volume greater than or equal to 0.4 ml/kg compared with 58% of the control patients (P = 0.77). Eighty three patients had sufficient gastric fluid for pH determination; of these 34/35 (97%) in the study group and 44/48 (92%) in the control group had a gastric fluid pH less than or equal to 2.5. Using a linear analog scale parents rated the children in the study group to be less irritable (P less than 0.001) and to have had a better overall preoperative experience (P less than 0.01) compared with the control patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparison of gastric emptying of soluble solid meals and clear fluids matched for volume and energy content: a pilot crossover study

We previously demonstrated that the gastric emptying time of different liquids with the same volume mainly depended on their energy content, regardless of differences in composition. In this crossover study, we investigated whether the same applies when soluble solid foods are ingested with water. Ten healthy volunteers ingested one of five test diets consisting of two test meals (Calorie Mate^® 100 and 200 kcal) and three test solutions (water and glucose solutions of 100 and 200 kcal), each given in a volume of 400 ml, and then underwent ultrasonography to measure the gastric antral cross‐sectional area every 10 min for 120 min. The gastric emptying time was defined as the time for the antral cross‐sectional area to revert to its initial value. When test diets with the same energy content were ingested, the gastric emptying curves were nearly identical, regardless of whether the original form was solid or liquid. The median (IQR[range]) gastric emptying times of Calorie Mate^® of 100 kcal with water vs. isocaloric glucose solution were 65 (60–78 [50–80]) vs. 65 (60–70 [50–80]) min (p = 0.58), and for Calorie Mate^® of 200 kcal with water vs. isocaloric glucose solution they were 100 (93–108 [90–120]) vs. 105 (90–110 [90–120]) min (p = 0.54). The median (IQR [range]) for water was 40 (30–40 [30–50]) min. Energy content may be a critical determinant of the gastric emptying time when ingesting soluble solid diets with water.     

A cohort evaluation of the paediatric i-gel(™) airway during anaesthesia in 120 children

We studied the i‐gel? in 120 anaesthetised children (92 boys, 28 girls; median (IQR [range]) age (3 ‐7 [0.4 ‐13]) years and weight 19 (15–26 [7–35]) kg) to assess efficacy and usability. Insertion was successful on the first/second/third attempt in 110/8/1 children and failed in one child. Median (IQR [range]) insertion time was 14 (9–16 [6–200]) s. Manual ventilation was possible in all cases, although excess leak precluded a tidal volume above 7 ml.kg^?1 in three children. Fibreoptic inspection through the i‐gel revealed a clear view of the vocal cords in 40 out of 46 cases (87%). Median (IQR [range]) leak pressure was 20 (16–26 [8–30]) cmH₂O. During maintenance of anaesthesia, 16 manipulations were required in 11 children to improve the airway. One child regurgitated without aspirating. Other complications and side effects were infrequent. The i‐gel was inserted without complications, establishing a clear airway and enabling spontaneous and controlled ventilation, in 113 (94%) children. You can respond to this article at http://www.anaesthesiacorrespondence.com     

Ultrasound assessment of gastric contents in children undergoing elective ear,nose and throat surgery: a prospective cohort study

Ultrasound examination of the gastric antrum allows reliable assessment of gastric contents and volume. Postoperative assessment of gastric contents before recovery from anaesthesia could help the physician to choose the most appropriate extubation technique after surgery in children. In this prospective observational study, we assessed whether significant changes occurred in gastric contents during the intra‐operative period in children undergoing elective ear, nose and throat (ENT) surgery. Children aged between six months and 16 years were recruited consecutively. Ultrasound examination of the antrum was performed before induction of anaesthesia and at the end of surgery before tracheal extubation, and included quantitative and qualitative assessment of gastric contents. The mean (SD) gastric volume was 0.28 (0.30) ml.kg^?1 before surgery and 0.27 (0.30) ml.kg^?1 after surgery, p = 0.82. No solid contents were identified in the antrum, and the gastric volume was < 1.5 ml.kg^?1 in all patients during both ultrasound examinations. Our results suggest that, after elective ENT surgery, children are not at risk of a full stomach before tracheal extubation, and that pulmonary aspiration of blood that may occur after elective ENT surgery is probably not related to regurgitation of ingested blood from the stomach.     

A randomised controlled trial of fibrinogen concentrate during scoliosis surgery

Bleeding and blood transfusion are common after scoliosis surgery. Fibrinogen is essential for blood clot formation and depletes quickly during haemorrhage. We randomly allocated 102 children 12–18 years old having surgery for idiopathic scoliosis, 51 to intra-operative fibrinogen concentrate 30 mg.kg⁻¹ (maximum 2 g) and 51 to saline placebo. Fibrinogen reduced peri-operative blood loss by a median (95%CI) volume of 155 (5–320) ml, from a median (IQR [range]) of 1035 (818–1420 [400–3030]) ml to 885 (755–1155 [270–2645]) ml, p = 0.04. Seven and four children received allogeneic red blood cell transfusion after fibrinogen and placebo, respectively, p = 0.34. There were no side-effects.     

Benefits of oral administration of an electrolyte solution interrupting a prolonged preoperatory fasting period in pediatric patients

PURPOSE: The aim of this study was to evaluate the benefits of an oral isosmolar solution of electrolytes (ISE) administered to interrupt a prolonged fasting period in children undergoing an elective surgical procedure under general anesthesia. METHODS: Forty unpremedicated children aged 3 to 12 years, ASA I, undergoing a surgical procedure requiring general anesthesia were assigned randomly to 1 of 2 groups. Group 1 consisted of patients with an overnight fasting period for milk and solids of at least 8 hours. In group 2, patients under a similar fasting period received a volume of 4 mL/kg of an oral ISE 3 hours before completing the fasting period. After anesthetic induction, blood glucose level (BGL) was quantified, and patients underwent an endoscopic examination to obtain the gastric content to determine the residual gastric volume (RGV) and pH levels. RESULTS: In group 1, the RGV was 0.78 +/- 0.44 mL/kg, pH was 1.75 +/- 0.38, and BGL was 86.4 +/- 14.5. In group 2, the RGV was 0.40 +/- 0.29 mL/kg, pH was 3.18 +/- 0.61, and BGL was 85.1 +/- 12.6. Only RGV and pH were significantly different between groups. CONCLUSION: A prolonged fasting period interrupted with oral ISE administration resulted in an RGV of low risk, without counterbalancing a potential fasting-induced hypoglycemia.     

Comparison of continuous epidural infusion of fentanyl and bupivacaine with intermittent epidural administration of morphine for postoperative pain management in children

Background: The aim of this study was to compare epidural infusion of bupivacaine and fentanyl and intermittent epidural morphine with regard to analgesic effect, and incidence and severity of side effects in children undergoing major abdominal or genito-urological surgery in order to improve the postoperative pain management of children. Methods: A double-blind, block-randomised study design was used. Thirty-one children aged 3 months to 6 years undergoing major abdominal or genito-urological surgery were studied. After induction of anaesthesia a lumbar epidural catheter was placed at L_3–4 or L_4–5. Postoperatively, the children received either 30 μg/kg of morphine every 8 h or a continuous infusion of fentanyl 2 μg/ml and bupivacaine 1.0 mg/ml at a rate of 0.25 ml.kg^-1.h^-1. All children additionally received rectal paracetamol in doses of 50–100 mg.kg^-1. d^-1 on a regular basis, and if necessary supplementary intravenous morphine in doses of 50 μg/kg. Postoperatively, pain, administration of supplemental morphine and side effects were recorded 5 times by one observer during the day of surgery and the first postoperative day. All children had an epidural catheter throughout the study period. Results: Both regimens provided effective analgesia, but significantly better pain relief was obtained in children receiving the fentanyl/bupivacaine regimen. Sedation, pruritus, vomiting, and administration of antiemetics were seen in both treatment groups, and even though both the incidence and severity of side effects tended to be higher in children receiving morphine, no statistically significant difference was found. No episodes of respiratory depression or motor blockade were noticed. Conclusion: Continuous epidural infusion of fentanyl and bupivacaine was found to be superior to intermittent epidural morphine. The initial regimen should be fentanyl 2 μg/ml and bupivacaine 1.0 mg/ml infused at a rate of 0.25 ml. kg^-1. h^-1.