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Intraperitoneal Glucose Tolerance Test, Measurement of Lung Function, and Fixation of the Lung to Study the Impact of Obesity and Impaired Metabolism on Pulmonary Outcomes
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Effects of Prolonged Preoperative Fasting on Blood Glucose Levels in Pediatric Elective Surgeries: A Systematic

Srinivasan Ramachandran1, Pankaj Kundra1, Savitri Velayudhan2

  • 1Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, Puducherry, India.

Paediatric Anaesthesia
|March 8, 2026
PubMed

Insights

Prolonged pre-operative fasting in children may not increase hypoglycemia risk, but adherence to guidelines is recommended. Standardized protocols are needed for clearer results in future pediatric surgical care.

Area of Science:

  • Pediatric Anesthesiology
  • Clinical Practice Guidelines
  • Surgical Patient Care

Background:

  • Clinical practice for pre-operative fasting in pediatric patients lacks standardization, despite existing guidelines.
  • Prolonged fasting in children can lead to complications, notably hypoglycemia.
  • This systematic review and meta-analysis (SRMA) addresses the impact of prolonged pre-operative fasting on hypoglycemia incidence in pediatric surgical patients.

Purpose of the Study:

  • To assess the effect of prolonged pre-operative fasting on hypoglycemia incidence in pediatric patients undergoing elective surgery.
  • To synthesize evidence from relevant studies regarding fasting duration and hypoglycemia risk.
  • To identify needs for standardized outcome definitions and fasting protocols.

Main Methods:

  • Systematic literature search of Medline, Scopus, Cochrane Library, and Google Scholar.
  • Inclusion of observational studies and randomized controlled trials (RCTs) reporting fasting duration and hypoglycemia incidence.
  • Calculation of pooled relative risk (RR) for hypoglycemia from RCTs.

Main Results:

  • The SRMA included 42 studies (15 RCTs, 27 observational) with 5121 pediatric patients.
  • Significant heterogeneity observed in definitions of hypoglycemia, fasting duration, and incidence rates.
  • Pooled RR for hypoglycemia with prolonged fasting was 2.0 (95% CI: 0.57-7.03), not statistically significant, but suggested a trend towards lower risk with adherence to recommended durations.

Conclusions:

  • A need exists for standardized outcome definitions and fasting protocols to improve future study comparability.
  • The meta-analysis indicated a variable relationship between fasting duration and hypoglycemia incidence.
  • Structured interventions are suggested to implement guidelines and mitigate hypoglycemia risks in clinical practice.
Abstract

Keywords:
childfasting ketosishypoglycemia

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