Paediatric glucose homeostasis during anaesthesia

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.