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Preoperative starvation and blood glucose concentrations in children undergoing inpatient and outpatient anaesthesia
Insights
For children over 6 months undergoing anesthesia, overnight fasting is recommended to prevent hypoglycemia and vomiting. Morning surgery after overnight fasting is the safest approach for pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Clinical Nutrition
- Pediatric Endocrinology
Background:
- Hypoglycemia and risk of emesis are concerns during pediatric anesthesia.
- Fasting guidelines for pediatric surgical patients vary.
Purpose of the Study:
- To evaluate blood glucose levels in pediatric patients undergoing anesthesia.
- To compare outcomes between fasted and fed children.
- To determine optimal fasting protocols for pediatric anesthesia.
Main Methods:
- Blood glucose concentrations were measured in 82 inpatient and 46 outpatient pediatric cases (6 months to 9 years).
- Inpatients were randomized to overnight fasting (Group A) or feeding 6 hours prior (Group B).
- Outpatients fasted from bedtime.
Main Results:
- No significant difference in mean blood glucose between fasted inpatients and outpatients.
- Only 1% of fasted children had blood glucose < 40 mg/dL.
- Group B (fed 6h prior) showed higher mean blood glucose than Group A, significant in children > 4 years.
Conclusions:
- Overnight fasting is effective in preventing hypoglycemia in pediatric surgical patients.
- For children over 6 months, overnight fasting and morning surgery minimize risks of hypoglycemia and emesis.
- Standardized fasting protocols are crucial for pediatric anesthesia safety.
Abstract:
Blood glucose concentrations were measured in 82 children undergoing inpatient anaesthesia and in 46 children undergoing anaesthesia as outpatients. The children were aged between 6 months and 9 yr. Outpatients were fasted from bedtime, while inpatients were randomly allocated to two groups. In group A the children were fasted from bedtime, whereas in group B the children were fed 6 h before anaesthesia. There was no difference in mean blood glucose concentration between the fasted inpatients and outpatients nor between children younger than, or older than, 4 years of age. A blood glucose concentration of less than 40 mg dl-1 was found in only one of the fasted children (1%). The mean blood glucose concentration was greater in group B than A, but only significantly so for children older than 4 yr. It is concluded that to minimize the risks of hypoglycaemia and inhalation of vomit on induction of anaesthesia children older than 6 months should be fasted overnight and operated on in the morning.