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Pediatric patients on ketogenic diet undergoing general anesthesia-a medical record review

Elif Soysal1, Heike Gries2, Carter Wray1

  • 1Pediatric Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97539, USA.

Journal of Clinical Anesthesia
|November 23, 2016
PubMed

Insights

General anesthesia appears safe for pediatric patients on a ketogenic diet (KD) for epilepsy. While minor complications occurred, they were mild and resolved quickly, indicating manageable risks for this population.

Area of Science:

  • Anesthesiology
  • Pediatric Neurology
  • Medical Nutrition Therapy

Background:

  • The ketogenic diet (KD) is an established therapy for intractable pediatric epilepsy.
  • Anesthesia management for children on KD requires careful consideration due to potential metabolic alterations.

Purpose of the Study:

  • To evaluate the safety and identify guidelines for anesthesia management in pediatric patients undergoing general anesthesia while on a ketogenic diet (KD).

Main Methods:

  • Retrospective review of medical records for pediatric patients (ages 1-15) on KD who received general anesthesia between 2009 and 2014.
  • Analysis included patient demographics, seizure history, procedure type, perioperative blood chemistry, anesthetic agents, and postoperative complications.

Main Results:

  • 33 procedures were performed on 24 pediatric patients on KD. Three patients experienced complications potentially related to KD and anesthesia: increased seizures, metabolic acidosis, and respiratory distress with increased seizure activity.
  • These complications were generally mild, with seizure activity returning to baseline within 24 hours for two patients.

Conclusions:

  • General anesthesia is relatively safe for pediatric patients on a ketogenic diet (KD).
  • Careful fluid management (e.g., considering normal saline cautiously) and awareness of potential drug-induced changes in ketogenic status are crucial.
  • Monitoring for metabolic acidosis and seizure activity is recommended during the perioperative period.
Abstract

Keywords:
AnesthesiaGeneralKetogenic dietKetosisPostoperative complications

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