• Mona Raafat Elghamry, Amira Mahfouz Elkeblawy, Abdelrhman Mohamed Alshawadfy, and Kareem Mohammed Ramadan.
• Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
• Acta Anaesthesiol Scand. 2025 Jan 1; 69 (1): e14566e14566.

BackgroundPreoperative fasting aims to reduce the risk of pulmonary aspiration. Our aim was to compare the incidence of increased gastric content after preoperative liberal versus a standard fasting in children.MethodTwo hundred children, presented for elective surgeries, were instructed to follow either 6-4-2 (standard group) or 6-4-0 (liberal group) preoperative fasting regimens. Preoperative ultrasound was used to evaluate gastric contents. The primary outcome was the proportion of patients with an "at-risk stomach." Secondary outcomes included qualitative and quantitative gastric assessment, last meal, actual fasting duration, regurgitation, vomiting, aspiration incidence, surgery cancellation rate, and complications of prolonged fasting (e.g., hunger).ResultsThe actual fasting duration was significantly longer than prescribed in each group (p < 0.001 for both groups) and was significantly longer in the standard group (CI95%: 0.744-2.016, medium effect size η2 = 0.068). In the liberal group, 3% of patients had an "at-risk stomach," and 2% of cases were canceled. Qualitative gastric assessment was comparable between the two groups (OR 1.536, CI95%: 0.883-2.670, low effect size Cramer V = 0.139). However, the estimated gastric volume/weight ratio was significantly increased in the standard group (CI95%: 0.114-0.214; large effect size η2 = 0.171). In the standard group, 9% of patients were hungry, and 10% were thirsty; no patients experienced adverse effects in either group.ConclusionProlonged preoperative fasting may be unnecessary. The 6-4-0 fasting regimen can be applied to pediatric patients before elective surgeries without increasing the incidence of "at risk stomach," but further studies with larger sample size are needed to confirm these results.Trial RegistrationClinicalTrials.gov (Trial no.: NCT04961814).© 2024 Acta Anaesthesiologica Scandinavica Foundation.

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