Prevalence of Children at High Risk for Pulmonary Aspiration Assessed by Gastric Ultrasonography in Elective Surgical Patients


  • Sutthirak Kuruhongsa, M.D. กลุ่มงานวิสัญญีวิทยา สถาบันสุขภาพเด็กแห่งชาติมหาราชินี
  • Patitha Chullabodhi, M.D. Queen Sirikit National Institute of Child Health
  • Duenpen Horatanaruang, M.D. Queen Sirikit National Institute of Child Health
  • Natthapong Lepananon, M.D. Queen Sirikit National Institute of Child Health
  • Trisana Soontrakom, M.D. Queen Sirikit National Institute of Child Health
  • Kannika Maokwang, B.N.S. Queen Sirikit National Institute of Child Health


gastric ultrasonography, gastric volume, gastric content, pediatric anesthesia, pulmonary aspiration


Background: Although pulmonary aspiration is rare, it is a serious anesthetic complication that can lead to significant morbidity and mortality. One of the important associated factors is the residual gastric content volume. Using the ultrasonography, the equipment generally used in anesthetic practice, to examine the gastric content and volume before anesthesia can help identify the high-risk patients. Therefore, this method can be one modality to prevent pulmonary aspiration and increase patient safety.Objective: To study the prevalence of pediatric patients at high risk for pulmonary aspiration assessed by gastric ultrasonography in elective surgical patients receiving standard preoperative fasting.Methods: 256 elective surgical pediatric patients, ASA physical status I-II, 1-15 years old were enrolled into this cross-sectional descriptive study. Preoperative gastric ultrasonography was performed in supine and right lateral decubitus position. The gastric content was evaluated and classified into 0-2 qualitative grading scale. The gastric volume per kilogram was also calculated by formula using antral cross-sectional area, the cut-off points for increasing aspiration risk were gastric volume more than 1.25 ml/kg or solid gastric content. The results were immediately reported to attending anesthesiologist before induction. Age, sex, BMI, fasting time, ASA status, grading scale and gastric volume were recorded and analyzed using descriptive statistics.Results: The prevalence of high-risk patient was 6.6%. Median fasting time of clear liquid and food or milk were 10 and 10.5 hours respectively. The median gastric volume was 0.7 ml/kg. None of the patients had solid gastric content or developed pulmonary aspiration.Conclusion: The prevalence of children at high risk for pulmonary aspiration was 6.6% in healthy elective surgical pediatric patients receiving standard preoperative care. The gastric ultrasonography was simple, convenient and feasible in the practice of anesthesia.


Download data is not yet available.

Author Biography

Patitha Chullabodhi, M.D., Queen Sirikit National Institute of Child Health

Queen Sirikit National Institute of Child Health


Borland LM, Sereika SM, Woelfel SK, Saitz EW, Carrillo PA, Lupin JL, et al. Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome. J Clin Anesth 1998; 10: 95-102.

Walker RW. Pulmonary aspiration in pediatric anesthetic practice in the UK: a prospective survey of specialist pediatric centers over a one-year period. Paediatr Anaesth 2013; 23: 702-11.

Tan Z, Lee SY. Pulmonary aspiration under GA: a 13-year audit in a tertiary pediatric unit. Paediatr Anaesth 2016; 26: 547-52.

Bunchungmongkol N, Somboonviboon W, Suraseranivongse S, Vasinanukorn M, Chau-in W, Hintong T. Pediatric anesthesia adverse events: the Thai Anesthesia Incidents Study (THAI Study) database of 25,098 cases. J Med Assoc Thai 2007; 90: 2072-9.

Rawlinson E, Minchom A. Pulmonary aspiration. Anaesth Intensive Care Med 2007; 8: 365-7.

American Society of Anesthesiologists. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology 2017; 126: 376-93.

Schmitz A, Thomas S, Melanie F, Rabia L, Klaghofer R, Weiss M, et al. Ultrasonographic gastric antral area and gastric contents volume in children. Paediatr Anaesth 2012; 22: 144-9.

Tomomasa T, Tabata M, Nako Y, Kaneko H, Morikawa A.

Ultrasonographic assessment of intragastric volume in neonates: factors affecting the relationship between intragastric volume and antral cross-sectional area. Pediatr Radiol 1996; 26: 815-20.

Spencer AO, Walker AM, Yeung AK, Lardner DR, Yee K, Mulvey JM, et al. Ultrasound assessment of gastric volume in the fasted pediatric patient undergoing upper gastrointestinal endoscopy: development of a predictive model using endoscopically suctioned volumes. Paediatr Anaesth 2015; 25: 301-8.

Bouvet L, Bellier N, Gagey-Riegel AC, Desgranges FP, Chassard D, Queiroz-Siqueira M. Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients: A prospective cohort study. Paediatr Anaesth 2018; 28: 906-13.

Desgranges FP, Gagey Riegel AC, Aubergy C, de Queiroz Siqueira M, Chassard D, Bouvet L. Ultrasound assessment of gastric contents in children undergoing elective ear, nose and throat surgery: a prospective cohort study. Anaesthesia 2017; 72: 1351-6.

Song IK, Kim HJ, Lee JH, Kim EH, Kim JT, Kim HS. Ultrasound assessment of gastric volume in children after drinking carbohydrate-containing fluids. Br J Anaesth 2016; 116: 513-7.

Cubillos J, Tse C, Chan VW, Perlas A. Bedside ultrasound assessment of gastric content: an observational study. Can J Anaesth 2012; 59: 416-23.

Bouvet L, Mazoit JX, Chassard D, Allaouchiche B, Boselli E, Benhamou D. Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume. Anesthesiology 2011; 114: 1086-92.

Bouvet L, Desgranges FP, Aubergy C, Boselli E, Dupont G, Allaouchiche B, et al. Prevalence and factors predictive of full stomach in elective and emergency surgical patients: a prospective cohort study. Br J Anaesth 2017; 118: 372-9.

Perlas A, Davis L, Khan M, Mitsakakis N, Chan VW. Gastric sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg 2011; 113: 93-7.

Perlas A, Mitsakakis N, Liu L, Cino M, Haldipur N, Davis L, et al. Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesth Analg 2013; 116: 357-63.

Van de Putte P, Vernieuwe L, Jerjir A, Verschueren L, Tacken M, Perlas A. When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients. Br J Anaesth 2017; 118: 363-71.

Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth 2014; 113: 12-22.

Perlas A, Arzola C, Van de Putte P. Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review. Can J Anaesth 2018; 65: 437-48.

Cook-Sather SD, Liacouras CA, Previte JP, Markakis DA, Schreiner MS. Gastric fluid measurement by blind aspiration in paediatric patients: a gastroscopic evaluation. Can J Anaesth 1997; 44: 168-72.

Pasunon P. Evaluation of Inter-Rater Reliability Using Kappa Statistics. The Journal of Faculty of Applied Arts 2015; 1: 2-20.

Brady M, Kinn S, O’Rourke K, Randhawa N, Stuart P. Preoperative fasting for preventing perioperative complications in children (Review). Cochrane Database Syst Rev 2005; 7: CD005285.

Mesbah A, Thomas M. Preoperative fasting in children. BJA Educ 2017; 17: 346–50.



How to Cite

Kuruhongsa S, Chullabodhi P, Horatanaruang D, Lepananon N, Soontrakom T, Maokwang K. Prevalence of Children at High Risk for Pulmonary Aspiration Assessed by Gastric Ultrasonography in Elective Surgical Patients. j dept med ser [Internet]. 2022 Jan. 21 [cited 2023 Jan. 31];46(4):91-9. Available from:



Original Article