Safety of preoperative oral intake of 25% maltodextrin for enhanced postoperative recovery in children
Kyselova I.V., Biliaiev A.V., Potebnya I.V., Pylypenko M.M.
Background and Goal of Study: Oral intake of carbohydrate drink 2 hours before surgery is one of components of Fast-track surgery program. The Enhanced Recovery After Surgery protocol recommends using 12,6% maltodextrin as a carbohydrate clear beverage. Children, depending on the age, might require less volume of oral fluids compared to adults. Therefore, due to cover caloric requirements children probably need more concentrated solution of carbohydrates. The aim of our study is to estimate safety of drinking a 25% maltodextrin beverage 2 hours before surgery in children.
Materials and methods: After receiving the ethic committee approval and parent's consent and child's assent (where possible) we conducted prospective pilot randomized study, which included 33 patients, aged 2-16 y.o. Patients had ASA status I and II and underwent 1-2 hours orthopaedics surgery. Group 1 (n=15) received 5 ml per kg oral 25% maltodextrin in clear water. Group 2 (n=18) was fasted. We evaluated the presence and volume of gastric content before induction of anaesthesia by ultrasonography of the stomach. After tracheal intubation, we aspirated from endotracheal tube and from nasogastric tube. If there was content, we measured its pH. Mean data were compared using the Student´s t-test and nonparametric methods.
Results and discussion: According to ultrasound data, gastric content defined seldom (1 and 2 cases per groups respectively), and volume did not exceed 0,4 ml per kg body weight. Volume of gastric content from nasogastric tube was comparable in both groups (0,37 ± 0,28 ml/kg in group 1 and 0,41 ± 0,52 ml/kg in group 2, P=0,719). pH of gastric content in group 1 was significantly higher (2,75 ± 1,34 vs. 1,95 ± 0,35, Р=0,02). There was no any tracheal content during aspiration from endotracheal tube. No clinical data for aspiration syndrome have been found in both groups. We did not receive any patient complaints or gastrointestinal complications after oral intake 25% solution of maltodextrin. 
Conclusion(s): Results of our pilot study suggest that preoperative oral intake of 25% maltodextrine instead of 12,6% 2 hours prior the surgery is safe and well tolerated in children aged from 2 years and older. Further research is necessary to find out clinical and outcome advantages of this strategy.