Presentation Details
| GRAACC-FAST: Implementing an ERAS-Aligned Fasting Protocol With Gastric Ultrasound in Pediatric Oncology Surgery Luis A.Rodriguez Linares, Simone Abib, Fernanda Souza. graacc/unifesp, sao paulo, Brazil |
Abstract
BACKGROUND: Pediatric oncology patients often experience prolonged preoperative fasting, which worsens discomfort, catabolism, and recovery and conflicts with ERAS principles. Most data on fasting and carbohydrate loading come from otherwise healthy children, not from those exposed to chemotherapy and radiotherapy. At our pediatric cancer center (GRAACC), we developed the GRAACC-FAST protocol, combining maltodextrin-based carbohydrate loading with point-of-care gastric ultrasound to safely shorten fasting in pediatric oncology surgery.
PURPOSE: We conducted a prospective quality-improvement project including elective pediatric oncology cases admitted via the CIPE unit (September–early November 2024). The protocol allowed 30 mL/kg (maximum 200 mL) of a clear maltodextrin drink up to 2 hours before anesthesia. Preoperative fasting time (last oral intake to OR entry) was recorded for all patients and plotted on a run chart using our historical mean fasting time (~11 h) as the baseline centerline. In a convenience sample, anesthesiologists performed bedside gastric ultrasound on arrival in the OR to categorize antral content as empty/low-risk vs high-risk. We monitored for aspiration events, case cancellations, or delays related to gastric contents.
RESULTS: After implementation of GRAACC-FAST, the run chart demonstrated nine consecutive data points below the historical mean, indicating a sustained reduction in fasting time. In the subgroup assessed with gastric ultrasound approximately 2 hours after maltodextrin ingestion, all examinations were compatible with an empty or low-risk stomach; no high-risk solid content, aspiration events, or cancellations due to gastric findings were observed.
CONCLUSIONS: An ERAS-aligned fasting and carbohydrate-loading protocol anchored by gastric ultrasound was feasible and safe in pediatric oncology patients. GRAACC-FAST shows that children undergoing chemotherapy and radiotherapy can receive maltodextrin clear liquids up to 2 hours before anesthesia, with ultrasound confirmation of low gastric risk and consistent fasting-time reduction. This innovation reinforces the role of structured pathways and POCUS integration in ERAS for pediatric oncology.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: We conducted a prospective quality-improvement project including elective pediatric oncology cases admitted via the CIPE unit (September–early November 2024). The protocol allowed 30 mL/kg (maximum 200 mL) of a clear maltodextrin drink up to 2 hours before anesthesia. Preoperative fasting time (last oral intake to OR entry) was recorded for all patients and plotted on a run chart using our historical mean fasting time (~11 h) as the baseline centerline. In a convenience sample, anesthesiologists performed bedside gastric ultrasound on arrival in the OR to categorize antral content as empty/low-risk vs high-risk. We monitored for aspiration events, case cancellations, or delays related to gastric contents.
RESULTS: After implementation of GRAACC-FAST, the run chart demonstrated nine consecutive data points below the historical mean, indicating a sustained reduction in fasting time. In the subgroup assessed with gastric ultrasound approximately 2 hours after maltodextrin ingestion, all examinations were compatible with an empty or low-risk stomach; no high-risk solid content, aspiration events, or cancellations due to gastric findings were observed.
CONCLUSIONS: An ERAS-aligned fasting and carbohydrate-loading protocol anchored by gastric ultrasound was feasible and safe in pediatric oncology patients. GRAACC-FAST shows that children undergoing chemotherapy and radiotherapy can receive maltodextrin clear liquids up to 2 hours before anesthesia, with ultrasound confirmation of low gastric risk and consistent fasting-time reduction. This innovation reinforces the role of structured pathways and POCUS integration in ERAS for pediatric oncology.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
Content Locked. Log into a registered attendee account to access this presentation.