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Perioperative blood glucose in a paediatric daycase facility: effects of fasting and maintenance fluid
1Department of Anaesthesia and Intensive Care, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
Insights
Prolonged preoperative fasting in children is common. Glucose-containing fluids for maintenance can cause harmful hyperglycemia, not hypoglycemia, in pediatric ambulatory surgery patients.
Area of Science:
- Pediatric Anesthesiology
- Intraoperative Fluid Management
- Pediatric Endocrinology
Background:
- Prolonged preoperative fasting is a common issue for children undergoing ambulatory surgery.
- The selection of intraoperative maintenance fluids remains a controversial topic.
- This study investigates preoperative fasting durations and maintenance fluid appropriateness in pediatric surgical patients.
Purpose of the Study:
- To assess the duration of preoperative fasting in children undergoing ambulatory surgery.
- To evaluate the appropriateness of intraoperative maintenance fluid solutions used in this population.
- To compare the effects of lactated Ringer's solution versus dextrose-saline on blood glucose levels.
Main Methods:
- A prospective randomized study involving 78 children undergoing ambulatory surgery.
- Children received either lactated Ringer's (LR) solution or 4.3% dextrose in 0.18% saline (DS) as maintenance fluid.
- Blood glucose was measured at induction and every 30 minutes; preoperative fasting duration was recorded.
Main Results:
- The mean preoperative fasting duration was 13.4 ± 3.5 hours, with no instances of hypoglycemia.
- Children receiving LR solution showed a steady increase in blood glucose levels.
- Children receiving dextrose-saline (DS) exhibited a significant increase in blood glucose levels, reaching 12.7 ± 3.98 mmol/L at 120 minutes.
Conclusions:
- A significant proportion of children undergoing ambulatory surgery experience prolonged preoperative fasting.
- The administration of glucose-containing maintenance fluids can lead to hyperglycemia, rather than preventing hypoglycemia, in pediatric surgical patients.
- Current maintenance fluid practices may pose risks due to induced hyperglycemia.
Background:
Many Children are daily exposed to prolonged preoperative fasting time. The choice of intraoperative maintenance fluid continues to be an issue of controversy. This study assesses the duration of preoperative fast among children undergoing ambulatory surgery and the appropriateness of the maintenance solutions used.
Patients And Methods:
Seventy-eight children undergoing ambulatory surgery were prospectively randomised to receive lactated Ringer's (LR) solution or 4.3% dextrose in 0.18% saline (DS) as maintenance fluid. The duration of preoperative fast was noted and the blood glucose measured at induction, but before infusion of any intravenous fluid, and subsequently every 30 min. Data were analysed with Statistical Packages for the Social Sciences 16.0 (SPSS incorporated, Chicago Ill, USA). P < 0.05 was considered as significant.
Results:
The age range was 3 months to 15 years (mean = 4.9 ± 3.6 years); mean weight was 16.3 ± 7.8 kg. The mean duration of fasting was 13.4 ± 3.5 h (range = 4-18.5 h), but no child was hypoglycaemic throughout the study. The mean blood glucose in the LR group rose steadily from 5.18 ± 0.98 mmol/L post-induction to a peak value of 7.40 mmol/L at 120 min. In the DS group, the mean blood glucose level increased from the post-induction value of 5.56 ± 0.86 mmol/L to 12.7 ± 3.98 mmol/L at 120 min.
Conclusion:
Most children undergoing ambulatory surgery at our facility are still exposed to prolonged fasting time. Glucose containing fluid often administered as maintenance fluid to treat the presumed hypoglycaemia causes worsening hyperglycaemia, which may be harmful.
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