Ultrasound-Guided Assessment of Gastric Volumes in Paediatric Patients Receiving Five Percent Dextrose Water Versus Plain Water Preoperatively: A Randomized Controlled Study

Introduction: Preoperative fasting guidelines recommend clear fluids up to two hours before surgery to prevent prolonged fasting times and pulmonary aspiration.Gastric ultrasound is a safe, valid, non-invasive and readily available tool that can be used to look for the residual gastric volumes (GVs) and to confirm the fasting status in case of doubtful fasting period.The aim of this study was to evaluate ultrasound-guided assessment of GVs in children receiving either 5% dextrose water or plain water preoperatively, and to look for the incidence of postoperative nausea and vomiting (PONV) and thirst.Methods: The study was approved by the Institutional Ethics Committee and registered with CTRI with trial number CTRI/2023/09/057732.This prospective, randomised, controlled study included 60 American Society of Anesthesiologists (ASA) I-II paediatric patients (5-12 years) undergoing elective surgery.Gastric antral cross-sectional area (CSA) and volumes were measured.Patients received 3 mL/kg of either 5% dextrose water (Group A) or plain water (Group B) two hours before surgery.The primary outcome was the measurement of GV at baseline and two hours.Ultrasound assessments were performed at baseline and two hours after fluid intake.Secondary outcomes included the incidence of PONV and thirst in the postoperative period.Results: The study found no significant differences in antral CSA or volume between the two groups at baseline and two hours.At baseline, CSA: t = -0.900,p=0.372, effect size (Cohen's d) = -0.232(95% CI: -0.580 to 0.220); GV: t= -0.800, p=0.427, effect size (Cohen's d) = -0.207(95% CI: -3.660 to 1.569).After two hours, CSA: t=0.579, p=0.565, effect size (Cohen's d) = 0.149 (95% CI: -0.268 to 0.486); GV: t = -0.561,p=0.577, effect size (Cohen's d) = -0.145(95% CI: -3.396 to 1.910).PONV was absent in both groups, and the prevalence of thirst did not differ significantly.Conclusion: Administering 5% dextrose water or plain water two hours preoperatively has similar effects on residual GVs in paediatric patients.The choice between the two fluids did not influence PONV or thirst significantly.