Impact of paediatric malnutrition on sevoflurane requirements and recovery: A pilot study

Malnutrition alters anaesthetic pharmacodynamics and pharmacokinetics, potentially affecting outcomes in children. We aimed to assess the impact of varying degrees of malnutrition on sevoflurane requirements, induction, and emergence times in children aged 2-9 years.

This prospective observational study was conducted at a tertiary health care institute. Hundred children with American Society of Anesthesiologists physical status I-II, undergoing short ophthalmic procedures (<15 min) under general anaesthesia, were enroled after ethics committee approval. Anthropometry [weight, height, mid-upper arm circumference (MUAC)] was recorded. Anaesthesia was induced with incremental sevoflurane in a 1:1 oxygen: nitrous oxide (6 L/min) mix. Induction and emergence times were recorded, and sevoflurane requirements were estimated using Dion's method. Nutritional status was classified using the Centers for Disease Control and Prevention Z-scores into: well-nourished or mildly, moderately, or severely malnourished. Data were analysed using two-way analysis of variance with Tukey's test, and Pearson's correlation (GraphPad Prism 8.0.2); P < 0.05 was significant.

Severely malnourished children exhibited significantly faster induction (P < 0.05), lower sevoflurane consumption, and prolonged emergence times compared to other groups. In this group, MUAC showed a strong positive correlation with induction time {r = 0.946; 95% confidence interval (CI): 0.85-0.98; P < 0.0001} and sevoflurane consumption (r = 0.726; 95% CI: 0.45-0.88; P < 0.001), and a strong negative correlation with emergence time (r = -0.952; 95% CI: -0.98 to -0.87; P < 0.001).

Severe malnutrition significantly alters anaesthetic response. MUAC may serve as a practical indicator for anaesthetic planning in such children.