Educational Review and Cases of Delayed Gastric Emptying in Children With Short Bowel Syndrome

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BACKGROUND: Patients with short bowel syndrome (SBS) and intestinal failure (IF) often require repeated sedation and anesthesia throughout their lives. These patients may present for elective procedures well-appearing, with appropriate preoperative fasting and no clear signs of gastrointestinal (GI) obstruction. Despite appearing to be at normal risk for anesthesia-related aspiration, unique physiologic adaptations in this patient population are likely to increase the risk of gastrointestinal dysmotility and aspiration. Current guidelines do not specifically identify IF and SBS as conditions associated with high aspiration risk. OBJECTIVES: To highlight the elevated risk of pulmonary aspiration in patients with SBS and IF and propose mitigation strategies for anesthesia providers. METHODS: We present two illustrative cases of patients with SBS who nearly experienced pulmonary aspiration under anesthesia. Both cases involved patients who exceeded standard fasting guidelines, lacked signs and symtoms of GI obstruction, and demonstrated normal to high stool output. RESULTS: These cases reveal that intestinal adaptation, chronic physiologic changes, and prior medical and surgical interventions can significantly impair gastric emptying and intestinal motility, thereby increasing aspiration risk. CONCLUSIONS: Standard preoperative assessments may not adequately identify aspiration risk in patients with SBS and IF. Anesthesia providers should consider tailored strategies to mitigate aspiration risk in this unique patient population that include minimizing sedation or, when greater depth of anesthesia is required, avoiding natural airways and supglottic airway devices in favor of rapid sequence induction and endotracheal intubation.

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