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Glycaemic profile of children undergoing anaesthesia (GLYCANA) at Mercy James Centre in Malawi: an observational
Furaha Nzanzu Blaise Pascal1,2, Singatiya Stella Chikumbanje3,4,5, Rachel Mbweza3,4
1Mercy James Centre for Paediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi. blaisepascal.furaha@gmail.com.
Insights
Perioperative glucose levels in Malawian children undergoing surgery show a significant increase, with prolonged fasting linked to lower blood sugar. Strategies like optimizing nutrition and IV fluid management can help maintain glucose homeostasis.
Area of Science:
- Paediatric Anaesthesia
- Surgical Metabolism
- Glucose Homeostasis
Background:
- Glucose dysregulation (hypoglycaemia and hyperglycaemia) during paediatric anaesthesia and surgery can lead to adverse outcomes.
- No prior studies have investigated glucose homeostasis in children undergoing surgery in Malawi.
- This study addresses this gap by assessing perioperative glucose levels in Malawian children.
Purpose of the Study:
- To assess perioperative glucose levels in children undergoing anaesthesia at Mercy James Centre (MJC) for Paediatric Surgery in Blantyre, Malawi.
- To identify factors influencing glucose homeostasis during paediatric surgery.
Main Methods:
- Observational cross-sectional study of 100 children (1 day to 15 years) undergoing anaesthesia at MJC.
- Data analysed using SPSS 28, with Student t-test and ANOVA for comparing means (significance level p < 0.05).
Main Results:
- A significant increase in glycaemia was observed from anaesthesia induction to the end of the procedure (p < 0.001).
- Prolonged fasting times (87% of patients) were associated with lower mean blood glucose.
- Factors like nutrition status, procedure type, dextrose in IV fluids, and duration were linked to higher glycaemia.
Conclusions:
- Glycaemia tends to increase during paediatric anaesthesia and surgery.
- Strategies to maintain blood sugar homeostasis include recommended fasting times, optimizing nutritional status, and judicious use of dextrose in IV fluids (e.g., <2.5%).
Background:
Hypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in children and can lead to severe adverse clinical outcomes. No study, as far as we know, has investigated glucose homeostasis in children undergoing surgery in Malawi. The aim of this study was to assess perioperative glucose levels of the children undergoing anaesthesia at Mercy James Centre (MJC) for Paediatric Surgery, Blantyre, Malawi.
Methodology:
This was an observational cross-sectional study. We looked at 100 children aged 1 day to 15 years anaesthetised at MJC. Data were analysed using SPSS 28. Student t test and Analysis of the variance (ANOVA) were used to compare means. The level of significance was 5%.
Results:
Male children represented 68%. The median age was 2.2 years. Sixten percents of patient were underweight. Fasting times were prolonged for 87%. Maintenance IV fluid with 2.5% dextrose was given to 14%. Overall, there was a significant increase of glycaemia from induction of anaesthesia to the end of the procedure. Hypoglycaemia was rare. The mean fasting glycaemia was 99.04 mg/dL ± 1.8, 116.95 mg/dL ± 34.2 at 30 min into the procedure and 127.62 mg/dL ± 46.8 at the end of the procedure. The differences in means were statistically significant (p < 0.001). Prolonged fasting times was associated with lower blood glucose means whereas nutrition status, type of the procedure, addition of dextrose in the fluid, and duration of procedure were associated with higher glycaemia means.
Conclusion:
Glycaemia increases under anaesthesia and surgery. Recommended fasting times, optimising nutritional status, when possible, no dextrose or lower than 2.5% dextrose in IV maintenance fluid are possible strategies to maintain blood sugar homeostasis during paediatric surgery and anaesthesia.
