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Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric
B A Tudor-Drobjewski1, P Marhofer1, O Kimberger1
1Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Insights
Preoperative carbohydrate intake in children significantly reduced gastric content and postoperative nausea compared to standard fasting. This finding offers valuable insights for pediatric anesthesia fasting guidelines.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Gastroenterology
Background:
- Preoperative fasting in pediatric anesthesia causes discomfort and postoperative insulin resistance.
- Carbohydrate intake before surgery is not a well-established approach for children.
- Fasting can increase the inflammatory response to surgery in pediatric patients.
Purpose of the Study:
- To evaluate the effect of preoperative carbohydrate beverages on gastric content and perioperative discomfort in children.
- To compare standard preoperative fasting with carbohydrate loading in pediatric patients undergoing general anesthesia.
- To provide evidence for updated preoperative fasting guidelines in pediatric anesthesia.
Main Methods:
- 120 children undergoing gastroscopy under general anesthesia were randomized into two groups: standard fasting or carbohydrate beverage.
- Gastric content volume and pH were measured via endoscopic aspiration.
- Perioperative discomfort was assessed using pain scales and Visual Analog Scale (VAS), with blinded outcome evaluation.
Main Results:
- Carbohydrate loading resulted in significantly less gastric content compared to fasting (P=0.01).
- Fewer patients in the carbohydrate group experienced postoperative nausea (P=0.028), with no difference in vomiting.
- High preoperative VAS scores were less frequent in the carbohydrate group.
Conclusions:
- Preoperative carbohydrate intake effectively reduces gastric content, a key factor in preventing gastric aspiration.
- Carbohydrate loading can alleviate postoperative nausea in pediatric patients.
- This study contributes essential data for refining preoperative fasting protocols in pediatric anesthesia.
Background:
Preoperative fasting is a major cause of perioperative discomfort in paediatric anaesthesia and leads to postoperative insulin resistance, thus potentially enhancing the inflammatory response to surgery. Addressing these problems by preoperative carbohydrate intake has not been a well-defined approach in children.
Methods:
We randomised 120 children scheduled for gastroscopy under general anaesthesia to either a control group of standard preoperative fasting or a study group receiving a carbohydrate beverage (PreOp™; Nutricia, Erlangen, Germany). Their stomach contents were aspirated endoscopically, and the volume and pH measured. Perioperative discomfort was evaluated using, among other parameters, an observational pain scale in ≤4-yr-olds and a VAS in >4-yr-olds. The investigators doing the endoscopies and outcome evaluations were blinded to the study group allocation.
Results:
Compared with fasting, carbohydrate loading was associated with significantly less gastric content (P=0.01), fewer patients experiencing postoperative nausea (P=0.028), with no significant difference in postoperative vomiting. High preoperative VAS scores (>5) were recorded for only one child in the carbohydrate group vs five children in the fasting group. Bowel cleansing for simultaneous colonoscopies (n=61) made no difference to any of the intergroup findings.
Conclusions:
Preoperative carbohydrates can reduce nausea and gastric content, the latter being a surrogate parameter for the risk and severity of gastric aspiration into the lungs during anaesthesia. Our study adds knowledge for preoperative fasting guidelines in paediatric anaesthesia.
Clinical Trial Registration:
DRKS00005020.
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