Preoperative gastric ultrasound in children with
cerebral palsy: a cross-sectional observational study

Cristiane de Pauli Bernardin; Juliana Thomaz Menck; Bruna Bastiani dos Santos; Jorge Eduardo Fouto Matias

doi:10.1016/j.bjane.2026.844728

Original Investigation

Preoperative gastric ultrasound in children with cerebral palsy: a cross-sectional observational study

Ultrassonografia gástrica pré-operatória em crianças com paralisia cerebral: estudo observacional transversal

Cristiane de Pauli Bernardin, Juliana Thomaz Menck, Bruna Bastiani dos Santos, Jorge Eduardo Fouto Matias

http://dx.doi.org/10.1016/j.bjane.2026.844728 Braz J Anesthesiol, vol.76, n3, 844728, 2026

PDF

Downloads: 0

Abstract

Background

Pulmonary aspiration during anesthesia, though rare, can be catastrophic. Gastric ultrasound provides an objective assessment of gastric contents and may be particularly relevant for children with Cerebral Palsy (CP), who are at risk of delayed gastric emptying.

Methods

We conducted a cross-sectional study in a pediatric hospital including children scheduled for elective surgery per ASA fasting guidelines. Preoperative gastric ultrasound measured antral CSA in right lateral decubitus, and gastric volume was estimated using the Perlas formula. Fasting time, medication use, and clinical data were recorded. Group comparisons used Wilcoxon, Fisher’s exact, or Chi-Square tests; multiple linear regression adjusted for confounders.

Results

Sixty-two children were studied: 30 with Cerebral Palsy (CP) and 32 controls. No patient exceeded the high-risk gastric volume threshold (1.5 mL.kg^-1) and no surgeries were cancelled. CP patients had shorter fasting times (6.5 vs. 8.0 h; p < 0.001) and higher medication use (47% vs. 6.3%; p < 0.001). Gastric CSA (4.0 vs. 3.0 cm²; p < 0.001) and estimated gastric volume per kg (0.7 vs. 0.4 mL.kg^-1; p < 0.001) were greater in CP. Multivariable models showed attenuation, but quantile regression confirmed higher lower CSA (+1.25 cm²; p = 0.007). Excluding medication users, CP remained associated with greater gastric volume.

Conclusions

Children with cerebral palsy exhibit larger CSA and higher gastric volumes despite adequate fasting. Although clinically safe, these findings support the role of gastric ultrasound in preoperative risk assessment for this vulnerable group.

Keywords

Anesthesia; Cerebral palsy; Fasting; Preoperative period; Pyloric antrum; Ultrasound

Resumo

Introdução

A aspiração pulmonar durante a anestesia, embora rara, pode ser catastrófica. A ultrassonografia gástrica fornece uma avaliação objetiva do conteúdo gástrico e pode ser particularmente relevante para crianças com Paralisia Cerebral (PC), que apresentam risco de esvaziamento gástrico retardado.

Métodos

Realizamos um estudo transversal em um hospital pediátrico incluindo crianças programadas para cirurgia eletiva conforme as diretrizes de jejum da ASA. A ultrassonografia gástrica pré-operatória mediu a área de secção transversal (CSA) do antro em decúbito lateral direito, e o volume gástrico foi estimado utilizando a fórmula de Perlas. Tempo de jejum, uso de medicações e dados clínicos foram registrados. Comparações entre grupos utilizaram os testes de Wilcoxon, exato de Fisher ou Qui-quadrado; regressão linear múltipla foi empregada para ajuste de fatores de confusão.

Resultados

Sessenta e duas crianças foram estudadas: 30 com Paralisia Cerebral (PC) e 32 controles. Nenhum paciente excedeu o limiar de alto risco para volume gástrico (1,5 mL.kg⁻¹) e nenhuma cirurgia foi cancelada. Pacientes com PC apresentaram menor tempo de jejum (6,5 vs. 8,0 h; p < 0,001) e maior uso de medicações (47% vs. 6,3%; p < 0,001). A CSA gástrica (4,0 vs. 3,0 cm²; p < 0,001) e o volume gástrico estimado por kg (0,7 vs. 0,4 mL.kg⁻¹; p < 0,001) foram maiores no grupo com PC. Modelos multivariáveis mostraram atenuação, mas a regressão quantílica confirmou maior CSA inferior (+1,25 cm²; p = 0,007). Excluindo usuários de medicação, a PC permaneceu associada a maior volume gástrico.

Conclusão

Crianças com paralisia cerebral apresentam maior CSA e maiores volumes gástricos apesar de jejum adequado. Embora clinicamente seguros, esses achados sustentam o papel da ultrassonografia gástrica na avaliação pré-operatória de risco desse grupo vulnerável.

Palavras-chave

Anestesia; Paralisia cerebral; Jejum; Período pré-operatório; Antro pilórico; Ultrassonografia

References

1. Green SM, Mason KP, Krauss BS. Pulmonary aspiration during procedural sedation: a comprehensive systematic review. Br J Anaesth. 2017;118:344−54.

2. Zhang E, Hauser N, Sommerfield A, Sommerfield D, von Ungern- Sternberg BS. A review of pediatric fasting guidelines and strat- egies to help children manage preoperative fasting. Paediatr Anaesth. 2023;33:1−8.

3. Ghimire A, Moharir A, Yamaguchi Y, Tram NK, Tobias JD. Preop- erative gastric point-of-care ultrasound in nonelective surgical procedures in pediatric-aged patients. Saudi J Anaesth. 2024;18:17−22.

4. Frykholm P, Disma N, Andersson H, et al. Pre-operative fasting in children: a guideline from the European Society of Anaesthe- siology and Intensive Care. Eur J Anaesthesiol. 2022;39:4−25.

5. Valencia A, Trujillo A, Arango F. Preoperative ultrasound evaluation of gastric contents in children one hour after ingestion of clear liquid: an observational study. Saudi J Anaesth. 2023;17:368−72.

6. American Society of Anesthesiologists Task Force on Preopera- tive Fasting. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126:376−93.

7. Valero Castañer H, Vendrell Jordà M, Sala Blanch X, Valero R. Preoperative bedside ultrasound assessment of gastric volume and evaluation of predisposing factors for delayed gastric emp- tying: a case−control observational study. J Clin Monit Comput. 2021;35:483−9.

8. Van de Putte P, Perlas A. Ultrasound assessment of gastric con- tent and volume. Br J Anaesth. 2009;113:12−22.

9. Valadares CP, Duarte MA, Silva RAP, Tavares Junior WC, Penna FJ. Correlation between gender, age, body mass index, body surface area and ultrasonographic gastric emptying time of a milk formula in children and adolescents. Rev Med Minas Gerais. 2008;18(Suppl 1):S33−9.

10. Araújo LA, Silva LR, Mendes FAA. Neuronal control and digestive manifestations in cerebral palsy. J Pediatr (Rio J). 2012;88:455−64.

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

12. Jones RB, Dockray GJ, Thompson DG. The effects of fasting duration on gastric emptying in man. Neurogastroenterol Motil. 2012;24:1−8.

13. Brindle ME, McDiarmid C, Short K, et al. Consensus guidelines for perioperative care in neonatal intestinal surgery. World J Surg. 2020;44:2482−92.

14. Zhang G, Huang X, Shui Y, Luo C, Zhang L. Ultrasound to guide the individual medical decision. Asian J Surg. 2020;43:1142−8.

15. Arzola C, Carvalho JCA, Cubillos J, Ye XY, Perlas A. Anesthesiolo- gists’ learning curves for ultrasound assessment of gastric con- tent. Can J Anaesth. 2013;60:771−9.

16. da Rocha CAT, Kamada LMK, de Andrade Filho PH, Villaverde IA, Shiro JYB, Silva JM. Ultrasonographic evaluation of gastric con- tent and volume. Rev Assoc Med Bras. 2020;66:1725−30.

17. Gulati S, Sondhi V. Cerebral palsy: an overview. Indian J Pediatr. 2018;85:1006−16.

18. Martinelli M, Staiano A. Motility problems in developmental dis- orders. In: Di Lorenzo C, Thapar N, Faure C, eds. Pediatric Neu- rogastroenterology, Cham: Springer International Publishing; 2017:303−9.

19. Andrew MJ, Parr JR, Sullivan PB. Feeding difficulties in children with cerebral palsy. Arch Dis Child Educ Pract Ed. 2012;97:222−9.

20. Han J, Na HS, Min S, Shin HJ. Preoperative gastric volume assessment using ultrasound in cerebral palsy pediatric patients: a prospective observational study. Braz J Anesthesiol. 2024;74:844541.

21. Alshryda S, Wright J. Development and reliability of a system to classify gross motor function. Clin Orthop Relat Res. 2014;472:575−7.

22. Szarka LA, Camilleri M. Methods for measurement of gastric motil- ity. Am J Physiol Gastrointest Liver Physiol. 2009;296:G461−75.

23. Perlas A, Mitsakakis N, Liu L, et al. Validation of a mathematical model for ultrasound assessment of gastric volume. Anesth Analg. 2013;116:357−63.

24. Manini ML, Burton DD, Meixner DD, et al. Feasibility and appli- cation of three-dimensional ultrasound for gastric volume mea- surement. J Pediatr Gastroenterol Nutr. 2009;48:287−93.

Submitted date:
06/20/2025

Accepted date:
01/04/2026