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Background and Aims Assessing intravascular volume in children clinically is subjective and inaccurate. Non-invasive ultrasound methods, such as assessing diameters and respiratory variations of the great vessels have enhanced volume assessment in emergency and intensive care settings as well as in adult patients. Paediatric fasting guidelines are often poorly implemented, leading to prolonged fasting. This study aimed to explore the association between inferior vena cava (IVC) and aortic diameters and their respiratory variations (IVC distensibility, collapsibility index, and caval-aortic index) with fasting duration and hypotension in paediatric patients undergoing surgery under general anaesthesia.Methods After ethical approval (IHECPGR/2020/PG/July/06) and informed consent, 50 patients aged 1–12 years, scheduled for elective non-cardiac surgery under general anaesthesia, were recruited. Exclusion criteria included shock, heart disease, or raised intra-abdominal pressure. IVC and aortic indices were measured at baseline, pre-operatively, and following induction of anaesthesia using a Sonosite M Turbo machine with a 2–6 MHz curvilinear transducer. Correlation analysis was performed between fasting duration, hypotension, and these indices.Results The mean age of the patients was 5.8 years. 64% of patients fasted for 6–12 hours, while 34% fasted for over 12 hours. There was a significant increase in the IVC collapsibility index (IVCCI) after fasting compared to baseline (mean difference 0.24, p value < 0.001) ( figure 1). The caval-aortic (IVC/Ao) index (maximum IVC/maximum aortic diameter) also increased significantly after fasting (mean difference 0.05, p value < 0.014). IVCCI was significantly higher in patients with hypotension (0.54 vs. 0.29, p < 0.001), while the aorto-caval index showed no substantial difference.Abstract EP192 Figure 1Box and whisker plot depicting inferior vena cava (IVC) and aorta parameters by fasting status. IVCCI - IVC collapsibility index, IVC max - Maximum IVC diameter, IVC min - Minimum IVC diameter, Ao - Aortic diameterConclusions In this study, IVCCI and the caval-aortic indices correlated with fasting duration. However, only IVCCI correlated with hypotension in paediatric patients undergoing elective surgery under general anaesthesia. Further studies on ultrasound based volume assessment in children are recommended.