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A study of preoperative fasting in infants aged less than three months
J H van der Walt1, J A Foate, D Murrell
1Department of Anaesthesia, Adelaide Children's Hospital, South Australia.
Insights
Infants under three months tolerate preoperative fasting well, showing no hypoglycemia. Their plasma glucose levels rise during anesthesia and surgery, suggesting careful monitoring rather than routine glucose supplements.
Area of Science:
- Pediatric Anesthesiology
- Neonatal Metabolism
- Surgical Patient Management
Background:
- Preoperative fasting guidelines for infants are crucial for managing metabolic and gastrointestinal risks.
- Understanding the impact of fasting on neonatal glucose homeostasis and gastric emptying is essential for safe surgical practices.
Purpose of the Study:
- To investigate the effects of preoperative fasting on plasma glucose levels and gastric emptying in infants under three months.
- To assess the safety and metabolic response of this age group to standard fasting periods before anesthesia and surgery.
Main Methods:
- Studied 62 infants (<3 months) after feeding with breast milk or formula.
- Monitored plasma glucose and assessed gastric contents before anesthesia.
- Analyzed intraoperative plasma glucose changes, considering fluid and opioid administration.
Main Results:
- No infants experienced hypoglycemia (plasma glucose < 2.2 mmol/l) after a 3-4 hour fast.
- Five percent of infants had significant residual gastric contents.
- Intraoperative plasma glucose levels increased significantly, unaffected by Hartmann's solution or low-dose opioids.
Conclusions:
- Infants under three months tolerate 3-4 hour preoperative fasts well without intraoperative hypoglycemia.
- A hyperglycemic response to anesthesia and surgery stress is observed in this age group.
- Routine intraoperative glucose supplementation may not be necessary, but plasma glucose monitoring remains important.
Abstract:
The effects of preoperative fasting on plasma glucose and gastric emptying was studied in 62 infants aged less than three months after a feed of either breast milk or an infant milk formula. Prior to induction of anaesthesia no infant was hypoglycaemic, defined as plasma glucose less than 2.2 mmol/l. Five per cent of infants had a significant volume of residual gastric contents. The mean intraoperative plasma glucose levels rose significantly and this was not influenced by the use of intravenous Hartmann's solution or low dose opioids. Infants in this age group tolerate three- to four-hour preoperative fasts well as no infant became hypoglycaemic intraoperatively. They demonstrate a hyperglycaemic response to the stress of anaesthesia and surgery, and may not need routine intraoperative glucose supplements although plasma glucose should still be monitored.