Impact of Different Fasting Strategies on Gastric Ultrasound and Anxiety Levels in Children

Summary

Children who undergo surgery are usually asked to stop eating and drinking for several hours before anesthesia to reduce the risk of stomach contents entering the lungs. However, long fasting times may cause discomfort, dehydration, low blood sugar, and increased anxiety in children. Recent guidelines suggest that clear liquids can safely be allowed closer to the time of surgery, and some enhanced recovery protocols even recommend giving carbohydrate-containing drinks before anesthesia. This study will compare three different preoperative fasting approaches in children undergoing elective inguinoscrotal surgery: traditional fasting, preoperative carbohydrate drinks, and the "Sip-Til-Send" approach, which allows clear fluids until the child is called to the operating room. The children's anxiety levels will be evaluated before surgery using a validated anxiety scale and assess stomach content and volume using gastric ultrasound. The secondary outcomes such as nausea, vomiting, pain, emergence delirium, and blood glucose levels will be evaluated. The results may help determine safer and more comfortable fasting strategies for children undergoing surgery.

Eligibility

Inclusion Criteria:

* Patients scheduled to undergo elective surgery under general anesthesia for circumcision, undescended testis, inguinal hernia, and/or hypospadias (inguinoscrotal surgery)
* Patients with an ASA physical status classification of I-II
* Patients able to tolerate oral intake in the preoperative period and comply with the assigned fasting protocol
* Written informed consent obtained from parents or legal guardians

Exclusion Criteria:

* Patients with ASA physical status III or higher
* Patients requiring emergency surgery
* History of gastroesophageal reflux disease, gastrointestinal motility disorders, or metabolic/neurological diseases affecting gastric emptying
* History of upper gastrointestinal surgery
* Active upper respiratory tract infection or lower respiratory tract infection within the previous 2-4 weeks
* Severe pulmonary disease, including uncontrolled or moderate-to-severe persistent asthma, bronchopulmonary dysplasia, cystic fibrosis, interstitial lung disease, or other chronic lung diseases
* Diabetes mellitus or endocrine/metabolic disorders that may affect perioperative glucose metabolism
* Obese patients with high aspiration risk (\>95th percentile for age)
* Cognitive or communication impairments that may interfere with compliance with the study protocol
* Grade 2 or Grade 3 gastric fullness detected on preoperative gastric ultrasonography
* Lack of written informed consent from parents or legal guardians for participation in the study

Conditions4

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