GASTRIC FLUID VOLUME IN INFANTS FOR PYLOROMYOTOMY

Purpose: To quantify gastric fluid volumes in infants with pyloric ste nosis presenting for pyloromyotomy and to demonstrate endoscopically t he efficacy of blind aspiration for gastric fluid recovery We hypothes ized that previous diagnostic contrast studies, preoperative nasogastr ic suction, and fasting interval would not affect these volumes, Metho ds: Seventy-five infants scheduled for pyloromyotomy were given atropi ne before induction bf anaesthesia. For those who had undergone preope rative nasogastric suction, the nasogastric tube was aspirated and rem oved. A 14 F multionificed orogastric catheter was blindly passed to a spirate gastric fluid for measurement. Following tracheal intubation, 15/75 subjects underwent gastroscopy to measure residual gastric fluid , Results: Gastric fluid volume removed by blind aspiration averaged 4 .8 +/- 4.3 ml . kg(-1) with 83% of patients having >1.25 ml . kg(-1). Although 14 of the 15 patients evaluated by endoscope had less than or equal to 1 ml residual gastric fluid, one had 1.8 ml . kg(-1). Recove ry of total gastric fluid volume by blind aspiration averaged 96 +/- 7 %, The large gastric fluid volumes were independent of a history of ba rium study, preoperative nasogastric suction, and fasting interval. Co nclusion: infants with pyloric stenosis have large gastric fluid volum es which are not substantially reduced by preoperative nasogastric suc tion. Blind aspiration of gastric contents prior to induction of anaes thesia provides a reliable estimate of total gastric fluid for most of these infants, although the occasional infant may retain a small amou nt of gastric fluid. The clinical importance of such a residual volume is uncertain.