Ultrasound assessment of gastric contents and volume may be used in children scheduled for elective surgery when fasting instructions have not been applied, and in children undergoing emergency surgery. (2C)

Cross-sectional area (CSA) of the antrum can be used as the surrogate parameter of choice for gastric content. Sonographic images of the antrum can most reliably be taken in right lateral decubitus position, using a defined protocol. (2B)

Qualitative grading systems are preferred over calculating gastric volumes. A trained examiner can use qualitative interpretation of sonographic imaging to differentiate solids from fluids as well as larger volumes from smaller ones. (2B)

Unless contraindicated, an early and liberal postoperative fluid intake should always be encouraged in children. (1B)

In patients who require temporary interruption of a VKA before surgery or a procedure and require normalization of the INR for the surgery or procedure, we recommend stopping VKAs approximately 5 days before surgery over stopping VKAs within a shorter time interval before surgery to allow adequate time for the INR to normalize. (1B)

In patients who have had temporary inter- ruption of a VKA before surgery or a procedure, we recommend resuming VKAs approximately 12 to 24 h (the evening of or the next morning) after surgery and when there is adequate hemostasis over resumption of VKAs closer to surgery. (1C)

In patients who require temporary interruption of a VKA before surgery or a procedure and whose INR is still elevated (ie, >1.5 ) 1 to 2 days before surgery, we suggest administeringlow-dose (ie, 1 to 2 mg) oral vitamin K to normalize the INR instead of not administering vitamin K. (2C)

In patients with a mechanical heart valve or atrial fibrillation or VTE at high risk for thromboembolism, we recommend bridging anticoagulation with therapeutic-dose SC LMWH or IV UFH over no bridging during temporary interruption of VKA therapy (Grade 1C); we suggest therapeutic-dose SC LMWH over IV UFH. (2C) In patients with a mechanical heart valve or atrial fibrillation or VTE at moderate risk for thromboembolism, we suggest bridging anticoagulation with therapeutic-dose SC LMWH,therapeutic-dose IV UFH, or low-dose SC LMWH over no bridging during temporary interruption of VKA therapy (2C); we suggest therapeutic-dose SC LMWH over other management options .. (2C) In patients with a mechanical heart valve or atrial fibrilla-tion or VTE at low risk for thromboembolism,we suggest low-dose SC LMWH or no bridging over bridging with therapeutic-dose SC LMWH or IV UFH. (2C)

In patients who require temporary inter-ruption of VKAs and are to receive bridging anticoagulation, from a cost-containment perspective we recommend the use of SC LMWH administered in an outpatient setting where feasible instead of inpatient administration of IV UFH. (1C)

In patients who are receiving bridging anticoagulation with therapeutic-dose SC LMWH, we recommend administering the last dose of LMWH 24 h before surgery or a procedure over administering LMWH closer to surgery. (1C); for the last preoperative dose of LMWH, we recommend administering approximately half the total daily dose instead of 100% of the total daily dose. (1C) In patients who are receiving bridging anticoagulation with therapeutic-dose IV UFH, we recommend stopping UFH approximately 4 h before surgery over stopping UFH closer to surgery. (1C)