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“Full Stomach” Despite the Wait: Point‐of‐care Gastric Ultrasound at the Time of Procedural Sedation in the Pediatric Emergency Department
Author(s) -
Leviter Julie,
Steele Dale W.,
Constantine Erika,
Linakis James G.,
Amanullah Siraj
Publication year - 2019
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13651
Subject(s) - medicine , sedation , stomach , odds ratio , confidence interval , gastric content , antrum , emergency department , anesthesia , nursing
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.