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Paediatric glucose homeostasis during anaesthesia
1Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, NT.
Insights
Healthy preschool children maintain blood glucose homeostasis after 8 hours of fasting. However, providing oral glucose 4 hours before surgery may increase the risk of pulmonary aspiration in children.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Endocrinology
Background:
- Perioperative fasting guidelines aim to minimize risks like hypoglycemia and aspiration.
- Limited data exists on the impact of pre-operative oral glucose administration on metabolic responses and gastric volume in young children.
Purpose of the Study:
- To compare the perioperative blood glucose regulatory response in fasted versus pre-operatively glucose-fed healthy preschool children.
- To assess the safety and metabolic implications of oral glucose administration prior to minor surgery in children.
Main Methods:
- Randomized controlled trial involving 20 healthy children (1-5 years) undergoing minor surgery.
- Two groups: fasted (no oral intake after midnight) and glucose (5% dextrose water 4 hours pre-op).
- Monitored plasma glucose, insulin, cortisol, growth hormone, and glucagon; analyzed gastric aspirate volume and pH.
Main Results:
- No significant differences in plasma glucose, insulin, cortisol, growth hormone, or glucagon levels between groups pre-operatively.
- Both groups maintained glucose homeostasis.
- Increased incidence of large gastric aspirates (>0.4 ml/kg) in the glucose group (33%) compared to the fasted group (10%).
Conclusions:
- Healthy preschool children can maintain glucose homeostasis with an 8-hour fast.
- Oral glucose administration 4-6 hours before surgery may elevate the risk of pulmonary aspiration due to increased gastric volume.
- Current fasting guidelines may need re-evaluation for specific pediatric populations.
Abstract:
The perioperative blood glucose regulatory response was compared in 20 healthy children (aged 1-5 yr) presenting for minor surgery and allocated randomly to either a fasted or a glucose group. All children received a milk feed at midnight. The fasted group received no oral intake thereafter, whereas the glucose group received 5% dextrose water 10 ml kg-1 orally about 4 h before operation. The mean plasma glucose concentrations in the two groups were similar before operation and were within normal limits. The pattern of change in the concentrations of plasma glucose, insulin, cortisol, growth hormone and glucagon were also similar between the two groups. Ten percent of patients in the fasted group and 33% in the glucose group had gastric aspirates in excess of 0.4 ml kg-1. The pH of all gastric samples was less than 2.5. The results suggest that healthy preschool children were able to maintain glucose homeostasis after 8 h of fasting. Feeding within 4-6 h before surgery may increase the risk of pulmonary aspiration.