GASTRIC VOLUME AND PH IN INFANTS FED CLEAR LIQUIDS AND BREAST-MILK PRIOR TO SURGERY

Recommendations for fasting intervals prior to anesthesia in pediatric patients have changed in recent years. There are few data concerning infants less than 1 yr of age fed clear Liquids or breast milk before surgery. We performed a prospective, blinded study to determine residu al gastric volumes and pH in this population. Approximately 2 h prior to surgery, 46 formula-fed infants ingested up to 8 oz of clear liquid s and 24 breast-fed infants nursed as usual. After induction of genera l anesthesia and tracheal intubation, gastric fluid samples were aspir ated by a blinded researcher who measured gastric volume and pH. Suffi cient gastric fluid for analysis was obtained from 10 (22%) of the inf ants fed clear liquids and 8 (33%) of the breast-fed infants. For the group fed clear liquids, the residual gastric volume was 0.3 +/- 0.9 m L/kg and the pH was 2.1 +/- 1.4. Eight (17%) had gastric volumes great er than or equal to 0.4 mL/kg, 2 (4%) had gastric volumes greater than or equal to 1 mL/kg, and 9 (90%) of 10 measured had pH less than or e qual to 2.5. In the breastfed group the residual gastric volume was 0. 71 +/- 1.1 mL/kg (P = not significant [NS]) and the pH was 2.6 +/- 1 ( P = NS). All eight (33%) breast-fed infants had gastric volumes greate r than or equal to 0.4 mL/kg (P = NS), seven (29%) had gastric volumes greater than or equal to 1 mL/kg (P = 0.03), and four (50%) of eight measured had pH less than or equal to 2.5 (P = NS). We conclude that f ormula-fed infants under 1 y of age who ingest clear Liquids up to 2 h prior to surgery are at no greater risk for pulmonary aspiration of g astric contents than are older children reported in previous studies. Breast feeding 2 h prior to surgery is not recommended.