{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:26:17Z","timestamp":1787646377762,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preoperative fasting guidelines have evolved from the traditional \u201cnil per os after midnight\u201d rule toward more liberal regimens. The European Society of Anaesthesiology and Intensive Care (ESAIC) and the Association of Pediatric Anesthetists of Great Britain and Ireland (APAGBI) now recommend a one\u2010hour clear fluid fast for children, yet objective evidence quantifying the gastric fluid volume (GFV) resulting from carbohydrate\u2010rich clear fluids at this abbreviated interval remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the effect of one\u2010 versus two\u2010hour fasting following the ingestion of 3\u2009mL\/kg of a carbohydrate\u2010rich clear fluid or plain water on GFV, as assessed by point\u2010of\u2010care gastric ultrasound (POCUS), in healthy children undergoing elective surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, randomized, double\u2010blind, parallel\u2010group trial (CTRI\/2024\/01\/061823) conducted at a tertiary referral centre from February 2024 to March 2025, 140 ASA I\u2013II children aged 1\u201312\u2009years undergoing elective non\u2010gastrointestinal surgery were randomized to one of four groups: (A) 10% glucose solution (Glucon\u2010D), 1\u2010h fast; (B) 10% glucose solution, 2\u2010h fast; (C) plain water, 1\u2010h fast; (D) plain water, 2\u2010h fast. All children received 3\u2009mL\/kg of the assigned fluid and fasted for the designated interval before POCUS assessment. The primary outcome was GFV in the right lateral position (RLP), calculated using the Spencer formula. Secondary outcomes included GFV distribution across three risk thresholds (0.8, 1.25, and 1.5\u2009mL\/kg), antral cross\u2010sectional area (CSA) in supine and RLP, qualitative Perlas antral grading (Grades 0\u20132), prevalence of pulmonary aspiration, and Visual Analogue Scale (VAS) comfort scoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All 140 enrolled children completed the study. Mean GFV in RLP was highest in Group A (0.947\u2009\u00b1\u20090.225\u2009mL\/kg), followed by Group C (0.825\u2009\u00b1\u20090.179\u2009mL\/kg), Group B (0.340\u2009\u00b1\u20090.317\u2009mL\/kg), and Group D (0.268\u2009\u00b1\u20090.322\u2009mL\/kg) (one\u2010way ANOVA,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No participant in any group exceeded a GFV of 1.5\u2009mL\/kg. In Group A, 57.1% of children had GFV between 0.9\u20131.25\u2009mL\/kg; 91.4% of Group B and 100% of Group D had GFV\u2009\u2264\u20090.8\u2009mL\/kg. Perlas Grade 2 was observed in 31.4% of Group A and 8.6% of Group C; none in the two\u2010hour groups. VAS comfort scores were significantly higher in Group A (8.31\u2009\u00b1\u20090.63) compared to Group D (6.66\u2009\u00b1\u20090.97) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No episodes of pulmonary aspiration occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Consumption of 3\u2009mL\/kg of a carbohydrate\u2010rich clear fluid 1\u2009h before anesthesia induction produces higher but clinically safe GFV (none exceeding 1.5\u2009mL\/kg) and superior patient comfort compared to conventional two\u2010hour fasting. These findings provide prospective, quantitative support for the implementation of one\u2010hour clear fluid fasting protocols in healthy pediatric patients undergoing elective surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>The trial was registered prospectively with the Clinical Trials Registry (India), CTRI\/2024\/01\/061823<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70289","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T07:51:01Z","timestamp":1787644261000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound\u2010Based Assessment of Gastric Fluid Volume in the Pediatric Population Undergoing Elective Surgery: A Prospective, Randomized, Double\u2010Blind Comparison of Carbohydrate\u2010Rich Clear Fluid Versus Water at One\u2010 and Two\u2010Hour Fasting Intervals"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-5047","authenticated-orcid":false,"given":"Aruna","family":"Parameswari","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Sri Ramachandra Institute of Higher Education and Research (SRIHER)  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4738-9172","authenticated-orcid":false,"given":"Amrit Kumar","family":"Som","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology NRS Medical College and Hospital  Kolkata West Bengal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9732-1952","authenticated-orcid":false,"given":"Kishore","family":"Manivannan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Sri Ramachandra Institute of Higher Education and Research (SRIHER)  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9157-6213","authenticated-orcid":false,"given":"Anisha Pauline","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Sri Ramachandra Institute of Higher Education and Research (SRIHER)  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4467-6657","authenticated-orcid":false,"given":"V.","family":"Rajesh Kumar Kodali","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Sri Ramachandra Institute of Higher Education and Research (SRIHER)  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6029-9185","authenticated-orcid":false,"given":"Mahesh","family":"Vakamudi","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Sri Ramachandra Institute of Higher Education and Research (SRIHER)  Chennai Tamil Nadu 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