title: General anesthesia and the ketogenic diet: clinical experience in nine patients.
abstract: OBJECTIVE
  To determine if children actively on the ketogenic diet (KD) can safely undergo general anesthesia (GA) for surgical procedures.
  
  
  METHODS
  The records of children treated with the KD at Children's Hospital (Boston, Massachusetts) from 1995 to the present were reviewed. The charts of children who had received GA while on the diet were evaluated with regard to demographics, procedure information, anesthesia records, blood chemistries, and perioperative course. Of 71 children on the KD during the period of the study, nine (12.7%) had procedures requiring GA while on the diet.
  
  
  RESULTS
  Nine children received GA for surgical procedures ranging from central line placement to hemispherectomy while on the KD. At the time of GA, the children ranged from age 1 to 6 years, and had been on the KD for 2-60 months. The patients received carbohydrate-free intravenous solutions perioperatively. Anesthesia duration ranged from 20 min to 11.5 h; for longer procedures, serum pH, glucose, and electrolyte levels were monitored. Serum glucose levels remained stable in all patients, but serum pH typically decreased; the largest reduction was to 7.16. In three procedures, patients received intravenous bicarbonate because of level of acidosis. There were no perioperative complications.
  
  
  CONCLUSIONS
  Children on the KD can safely undergo GA for surgical procedures. Although serum glucose levels appear to remain stable, serum pH or bicarbonate levels should be monitored because of the risk of metabolic acidosis.
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Valencia
authors.forename: Heidi
authors.initials: H
authors.lastname: Pfeifer
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Thiele
mesh_terms: D000367:Age Factors; D000768:Anesthesia, General; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004041:Dietary Fats / Q000008:administration & dosage / Q000378:metabolism; D004827:Epilepsy / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007223:Infant; D007657:Ketone Bodies / Q000096:biosynthesis / Q000097:blood; D007662:Ketosis / Q000097:blood / Q000209:etiology / Q000378:metabolism*; D008297:Male; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative
chemical_list: D000927:Anticonvulsants; D004041:Dietary Fats; D007657:Ketone Bodies