Preoperative fasting policies for children have shifted away from the traditional prolonged NPO approach toward shorter, evidence‑based clear fluid intervals. Professional bodies including the European Society of Anaesthesiology and Intensive Care (ESAIC) and the Association of Pediatric Anesthetists of Great Britain and Ireland (APAGBI) endorse a one‑hour clear fluid fasting interval in children. However, quantitative, prospective data measuring the resulting gastric fluid volume after ingestion of carbohydrate‑rich clear fluids at this abbreviated interval are limited. This study used point‑of‑care gastric ultrasound to provide objective measurements in a pediatric elective surgery population.
The primary aim was to compare gastric fluid volume (GFV) in the right lateral position after ingestion of 3 mL/kg of either a carbohydrate‑rich clear fluid (10% glucose solution, Glucon‑D) or plain water, with fasting intervals of one hour versus two hours in healthy children aged 1–12 years undergoing elective non‑gastrointestinal surgery. Secondary aims included categorizing GFV relative to predefined risk thresholds, measuring antral cross‑sectional area (CSA) in supine and right lateral positions, applying the Perlas qualitative antral grading (Grades 0–2), recording Visual Analogue Scale (VAS) comfort scores, and documenting any episodes of pulmonary aspiration.
This was a prospective, randomized, double‑blind, parallel‑group trial (CTRI/2024/01/061823) conducted at a tertiary referral centre between February 2024 and March 2025. One hundred forty ASA I–II children aged 1–12 years scheduled for elective non‑gastrointestinal surgery were randomized to four groups:
All participants received 3 mL/kg of the assigned fluid. Point‑of‑care gastric ultrasound (POCUS) was performed prior to anesthesia to assess antral measurements. Gastric fluid volume in the right lateral position (RLP) was calculated using the Spencer formula. The trial was double‑blind with respect to the fluid allocation and fasting interval assessment.
The predefined primary outcome was GFV in RLP (mL/kg). Secondary outcomes were:
All 140 enrolled children completed the study and contributed data to the planned analyses.
Mean GFV in the right lateral position differed significantly across groups (one‑way ANOVA, p < 0.001). Reported mean ± SD GFV (mL/kg) by group were:
No child in any group had GFV exceeding 1.5 mL/kg. Distribution relative to risk thresholds showed that 57.1% of Group A had GFV between 0.9–1.25 mL/kg. In contrast, 91.4% of Group B and 100% of Group D had GFV ≤ 0.8 mL/kg.
Qualitative Perlas grading identified Grade 2 (antral appearance consistent with higher content) in 31.4% of Group A and 8.6% of Group C; no Grade 2 cases were observed in either two‑hour fasting group (Groups B and D).
There were no reported episodes of pulmonary aspiration across the 140 study participants. Comfort measured by VAS scores favored the one‑hour carbohydrate drink: Group A had a mean VAS of 8.31 ± 0.63 versus Group D mean VAS of 6.66 ± 0.97, a difference that reached statistical significance (p < 0.001).
In this randomized pediatric study, ingestion of 3 mL/kg of a carbohydrate‑rich clear fluid one hour before anesthesia induction resulted in higher measured gastric fluid volume compared with two‑hour fasting, but none of the children exceeded a GFV of 1.5 mL/kg. The one‑hour carbohydrate group also reported higher comfort scores. Perlas Grade 2 appearances were more frequent after the one‑hour carbohydrate drink but were absent in the two‑hour groups.
The authors conclude that a 1‑hour clear fluid fasting policy using a small volume (3 mL/kg) of carbohydrate drink produces higher but clinically safe GFV in healthy children undergoing elective surgery, and it improves preoperative comfort. These data provide prospective, quantitative support for implementation of one‑hour clear fluid fasting protocols in this population.
The trial was registered prospectively with the Clinical Trials Registry (India), CTRI/2024/01/061823. Keywords reported by the authors include: carbohydrate loading; gastric fluid volume; gastric ultrasound; pediatric anesthesia; preoperative fasting; pulmonary aspiration.