The Effect of Mobilization on Gastric Emptying Time
Condition: Anesthesia; Fasting
Study type: Interventional

Summary: 
      ıntroduction Pulmonary aspiration under general anesthesia is a rare but serious complication
      in healthy patients undergoing elective surgery. In the preoperative period, negative
      metabolic, physiological, and/or psychological consequences may occur due to prolonged hunger
      time (1). It is important to shorten the preoperative fasting period to reduce anxiety and
      hunger, especially in pediatric patients (2).

      Material-Methods This study at Bursa Uludag University Hospital (January 2021- January 2022)
      involved 84 ASA (American Society of Anesthesiologists) class I-III patients aged 4-11 years
      undergoing elective urogenital surgery, with certain exclusions like gastrointestinal
      disorders and high BMI (Body Mass Index).

      Gastric antral area (GAA) was measured with ultrasound (USG) before liquid intake and at
      various intervals there after; 5, 10, 30, 60, 90 minutes. Patients were split into four
      groups based on liquid (water or apple juice) and activity level (rest or mobilization).
      Resting patients watched animations, while mobilized patients were encouraged to walk.
    

Detailed description: 
      This prospective study was carried out at Bursa Uludag University Hospital between January
      2021 and January 2022, following the approval of the local ethical committee (2021-7/26).
      Eighty-four ASA class I-III patients aged 4-11 years who were scheduled for elective
      urogenital surgery were included in the study. The parents were informed about the research,
      both verbally and in writing, and their consent was obtained. Patients with a pathology that
      prevents emptying in the upper gastrointestinal system, who have motility disorders in the
      gastrointestinal system, who are under follow-up due to diabetes mellitus (DM), who can-not
      cooperate, refuse to drink fluids or USG, do not provide consent from their families, have a
      history of lower esophagus or gastric operation, have a history of upper gastrointestinal
      bleeding in the last month, clinically significant hepatic or renal failure, and a BMI > 35
      kg m2 were excluded from the study.During the preoperative visit, the child's physical
      characteristics (sex, age, weight, height, and body mass index) and initial vital parameters
      (heart rate and noninvasive blood presure) were recorded. Oral intake was discontinued in all
      children according to our common protocol (two hours for clear liquids; six hours for
      semi-solid and solid foods)All patients were randomized according to a table created on a
      computer using the closed-envelope method. It was planned such that only the surgeons knew
      which group the randomized patients were in. The anesthesiologist who performed the USG
      measurements did would not know which group the patient belonged to. Informed consent was
      obtained after the study protocol was properly explained to the children in accordance with
      their parents and age. In the clinic, clear liquids (water or apple juice) at room
      temperature (22°C) were administered to the patients by a second anesthesiologist and clinic
      nurse, in accordance with the group. The gastric antral area (GAA) was measured with USG just
      before the intake of liquid (T0), at the 5th minute (T5), 10th minute (T10), 30th minute
      (T30), 60th minute (T60), 90th minute (T90) by the anesthesiologist. This planned procedure
      was performed on the morning of the day of the operation, at least two hours before the
      induction of anesthesiaThe patients were grouped according to the kind of liquid (water or
      apple juice) and physical activity (resting or mobilization). [Group WR [water+rest (n:19)],
      Group WM [water+mobilization (n:21)], Group AR [apple juice (49.6kcal/100 ml + rest (n:23)]
      and Group AM [apple juice (49.6kcal/100 ml) + mobilization (n:21)]]. All the clear liquids
      were administered at a dose of 5 ml/kg. Patients in the resting groups (WR and AR); sat
      between ultrasound examinations and watched the age-appropriate animation of their choice.
      Age-appropriate audiovisual interventions such as cartoons and interactive games are
      effective in reducing preoperative anxiety in children. However, the selection of audiovisual
      interventions according to the age of the child is crucial. Patients in the mobilized group
      (WM and AM) were encouraged to walk into the clinic and their rooms between the ultrasound
      examinations.During USG imaging, patients were placed in a 45° semi-recumbent, right lateral
      decubitus (RLD) position. A portable ultrasound device (Logic E® GE, Boston, MA, USA)
      equipped with a high-frequency linear array transducer (probe 8-12 MHz) was used to obtain a
      cross-sectional image of the gastric antrum. The gastric antrum was identified in the
      sagittal or sagittal oblique plane in the epigastrium, along the edge of the left lobe of the
      liver, and anterior to either the aorta or the inferior vena cava, according to the standard
      protocol. Gastric emptying is influenced by gravity and should be faster in an upright
      positionGAA, craniocaudal (D1) (cm) and anteroposterior (D2) (cm) of the antrum, including
      stomach wall, in the RLD position werw calculated using real-time USG (Logic E® GE, Boston,
      USA) linear probe (8-12 MHz) diameters. A single cross-section of the antrum was obtained in
      the sagittal plane containing the left lobe of the liver and the aorta or inferior vena cava
      and was considered a standard level for measuring craniocaudal and anteroposterior diameters.
      The values of these diameters were inserted into the formula below to calculate the antral
      GAA, which correlates with gastric volume (GAA = π × D1 × D2/4).

      A single investigator evaluated the hunger and thirst ratings of all children before drinking
      the beverages (0 min), and at 10, 15, 30, 60, and 90 min after drinking.
    

Intervention name(s): group WM; group WR; Group AR; Group AM
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Patients were given 5ml/kg dose of water and patients were mobilized.; Patients were given 5ml/kg dose of water and patients were rest.; Patients were given 5ml/kg dose of apple juice and patients were rest.; Patients were given 5ml/kg dose of apple juice and patients were mobilized.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Care Provider, Investigator)
Primary purpose: Other
Keywords: diagnostic imaging; fasting; anesthesia