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The effect of different pre-operative feeding regimens on plasma glucose and gastric volume and pH in infancy
Insights
Pre-operative feeding in infants undergoing surgery showed no hypoglycemia. Avoiding milk in the last feeding regimen for infants under three months reduces the risk of pulmonary acid aspiration.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Gastroenterology
Background:
- Optimizing pre-operative feeding regimens in infants is crucial for surgical safety.
- Understanding the impact of feeding on gastric physiology and metabolic status is essential.
- Previous studies have not fully elucidated the risks associated with different pre-operative feeding strategies in infants.
Purpose of the Study:
- To evaluate the effects of four distinct pre-operative feeding regimens on metabolic and gastric parameters in infants undergoing surgery.
- To assess the risk of pulmonary acid aspiration associated with different feeding practices.
- To determine the correlation between patient factors, fasting duration, and pre-operative glucose levels.
Main Methods:
- A study involving 123 infants under one year of age undergoing surgery.
- Measurement of plasma glucose, blood acid-base values, gastric volume, and gastric pH before and after anesthesia induction.
- Comparison of four different pre-operative feeding regimens.
Main Results:
- No hypoglycemia was observed in any group.
- No significant differences in plasma glucose or acid-base values were found between feeding groups.
- Infants under three months fed milk had increased gastric volume and lower pH, indicating a higher risk of pulmonary acid aspiration.
- A significant increase in plasma glucose occurred post-anesthesia induction across all groups due to stress.
Conclusions:
- Pre-operative feeding regimens in infants do not significantly impact glucose or acid-base balance prior to anesthesia.
- Avoiding milk in the final pre-operative feed for infants, especially those under three months, mitigates the risk of pulmonary acid aspiration.
- Timing the last feed according to the infant's usual pattern is safe if milk is excluded, minimizing aspiration risks.
Abstract:
The effects of four different pre-operative feeding regimens were studied in 123 children below the age of one year presenting for surgery. Plasma glucose concentrations, blood acid-base values, gastric volume and gastric pH were measured before and after induction of anaesthesia. No patient was found to be hypoglycaemic and there were no significant differences in plasma glucose concentration and acid-base values between the groups. No correlation was demonstrated between the age and weight of the patients and the duration of fasting and the plasma glucose concentration. There was a significant elevation of plasma glucose concentration in all four groups after induction of anaesthesia (P less than 0.001) compared with the pre-induction level which is a reflection of the stress of blood sampling and induction of anaesthesia. Infants less than three months of age in the milk-feed group had a significantly higher gastric volume with low pH (P less than 0.05) signifying a potentially greater risk of pulmonary acid aspiration. The practice of timing the last pre-operative feed in infancy according to the infant's normal feeding pattern does not appear to increase the risk factors for pulmonary aspiration, if milk is avoided.