Safe Surgery for Kids: How a Simple Ultrasound Is Changing the Game
Featured paper: Preoperative gastric point‑of‑care ultrasound in nonelective surgical procedures in pediatric‑aged patients
Disclaimer: This content was generated by NotebookLM and has been reviewed for accuracy by Dr. Tram.
Going into surgery is a stressful experience for anyone, but it can be especially scary for children and their parents. When a surgery is “nonelective”—meaning it wasn’t planned weeks in advance and needs to happen soon because of an injury or a sudden illness—there are extra safety concerns that doctors have to manage. One of the biggest worries is something called pulmonary aspiration. This happens when stomach contents, like food or liquid, accidentally enter the lungs while a patient is being put to sleep (anesthesia).
While this complication is rare, it is very serious and can lead to long hospital stays or the need for a breathing machine. To prevent this, doctors usually follow strict “NPO” rules—an abbreviation for nil per os, which is Latin for “nothing by mouth”. But in emergency situations involving pain, trauma, or medicine, these rules might not be enough.
A recent study published in the Saudi Journal of Anesthesia by researchers at Nationwide Children’s Hospital explored a high-tech way to make these surgeries safer: using point-of-care ultrasound (POCUS) to look inside a child’s stomach before the procedure.
The Problem: When “Nothing by Mouth” Isn’t Enough
The standard rules for fasting before surgery are well-known in the medical world: no clear liquids for 2 hours, no breast milk for 4 hours, and no solid food for at least 8 hours. These rules give the stomach enough time to empty itself naturally.
However, life isn’t always that simple. In nonelective cases—like a broken bone or an infected appendix—factors like intense pain, physical trauma, and the use of opioid painkillers can actually slow down how fast the stomach empties. This means a child might have followed the “no eating” rules perfectly, but because they are in pain or on medicine, their stomach might still be full.
Traditionally, if doctors are worried about a full stomach, they use a technique called Rapid Sequence Induction (RSI). This is a very fast way of putting a patient to sleep and placing a breathing tube to protect the lungs. While effective, RSI can be risky for children, who are more likely than adults to have their oxygen levels drop quickly during the process.
The Solution: A Window into the Stomach
This is where Point-of-Care Ultrasound (POCUS) comes in. POCUS is a fast, non-invasive tool that allows doctors to see what is happening inside the body in real-time at the patient’s bedside.
In the study, researchers used a small ultrasound probe to look at a specific part of the stomach called the gastric antrum. By measuring this area, they could calculate exactly how much fluid or food was left in the child’s stomach. The scan is so efficient that it usually takes less than five minutes to complete.
What the Study Found
The researchers looked at 100 patients between the ages of 3 and 17. Most of these children (59%) were there for nonelective procedures, such as fixing broken bones or removing an appendix. Many were in pain, and 27% of the emergency patients had already received opioids for pain control.
Despite these complicating factors, the results were very encouraging:
- Low Risk for Most: 98% of the children who were scanned were found to have a very low risk of aspiration.
- The Grading System: Doctors used a 3-point scale to rank the risk. Grade 0 meant the stomach was empty; Grade 1 meant there was a tiny bit of clear liquid (less than 1.5 mL per kilogram of body weight); and Grade 2 meant there was enough liquid or food to be considered high risk.
- Success of NPO: Among the 100 patients, 99 had followed the fasting rules for at least 6 hours. The ultrasound confirmed that nearly all of them (81 kids at Grade 0 and 16 kids at Grade 1) were safe for a standard, controlled anesthesia induction.
A Real-World Success Story
One specific case in the study perfectly illustrated why this tool is so useful. One patient scheduled for an elective surgery was scanned, and the ultrasound clearly showed solid food in their stomach.
When the doctors asked more questions, they discovered the patient had accidentally eaten breakfast that morning and hadn’t told anyone. Because of the ultrasound, the doctors were able to delay the surgery for four hours until a second scan showed the stomach was finally empty. This prevented a potentially dangerous situation that might have gone unnoticed without the technology.
Why This Matters for Patient Safety
The “preliminary data” from this study suggests that even when kids are in pain or on painkillers, they are usually at a low risk of aspiration if they have followed the NPO rules.
This is a big deal for anesthesiologists. If they can use an ultrasound to prove the stomach is empty, they don’t have to rush through a risky RSI. Instead, they can use a more “stable and controlled” method to put the child to sleep. This allows for a smoother transition into surgery, which is better for the child’s heart and lungs.
Furthermore, for trauma patients who might have other injuries—like a neck injury or a difficult airway—being able to avoid a rushed induction is much safer. A controlled approach helps prevent blood pressure drops and other complications that can happen when a patient is dehydrated or in shock.
Limitations and the Future
While the study is exciting, the authors noted a few limitations. For one, they didn’t include “true” emergencies where the patient has to be on the operating table within 60 minutes, as there wasn’t enough time to get consent for the study in those frantic moments. Additionally, sometimes things like gas in the colon or a patient’s body shape can make it hard to get a clear ultrasound picture (this happened in two of the 100 cases).
However, the main takeaway is clear: gastric ultrasound is a powerful, quick, and non-invasive way to check a patient’s safety in real-time.
Conclusion
The use of point-of-care ultrasound is changing how doctors think about “empty” stomachs. Instead of just guessing based on the clock, they can now use technology to see for themselves. This study shows that for most kids undergoing urgent surgery, following the standard fasting rules works—but having an ultrasound “backup” provides an extra layer of safety that can help doctors choose the best and most stable way to care for their young patients.
As this technology becomes more common, it could lead to a future where surgery is not only more successful but also much less stressful for families.