title: Randomized trial comparing overnight preoperative fasting period Vs oral administration of apple juice at 06:00-06:30 am in pediatric orthopedic surgical patients.
abstract: BACKGROUND
  We aimed to evaluate the efficacy of clear liquids orally administered at 06:00-06:30 am on the morning of surgery to reduce prolonged preoperative fasting periods.
  
  
  METHODS
  After obtaining informed parental consent, 100 children undergoing scheduled orthopedic surgical procedures, ASA I-II, were randomly allocated to two groups. In group 1, children underwent the typical overnight preoperative period and patients in group 2 received a commercial brand of apple juice (glucose 28 g in 250 ml) at 06:00-06:30 am on the day of surgery. Patients <3 years old received 15 ml.kg(-1) and older children 10 ml.kg(-1) to a maximum volume of 250 ml. All patients underwent overnight fasting for milk and solids.
  
  
  RESULTS
  Fasting time was 4.8 +/- 2.1 h (ranging from 3 to 11 h) in the group receiving apple juice at 06:00-06:30 am and 13.2 +/- 3.3 h (ranging from 5 to 19 h) in the overnight-fasting group (P < 0.05; 95% CI: -9.6 to -7.4 h). More patients were irritable (odds ratio, OR 4.5; 95% CI: 1.9-10.8) and dehydrated (OR 21.6; 95% CI: 5.9-79.0) in the overnight-fasting group. Glucose levels <2.7 mmol.l(-1) (50 mg.dl(-1)) were not reported in any case.
  
  
  CONCLUSIONS
  A 15 ml.kg(-1) of apple juice for patients of <3 years of age or 10 ml.kg(-1) for older children, at 06:00-06:30 am of the surgical morning is a simple procedure to prevent dehydration and to produce positive behavior in low-risk, pediatric surgical patients.
authors: Department of Anesthesia and Respiratory Therapy, Hospital Infantil de México Federico Gómez, Mexico DF, Mexico. caszam2002@yahoo.com.mx
authors: Carlos
authors: C
authors: Castillo-Zamora
authors: Luz A
authors: LA
authors: Castillo-Peralta
authors: Alejandro A
authors: AA
authors: Nava-Ocampo
mesh_terms: D001628:Beverages; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003681:Dehydration / Q000209:etiology; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005215:Fasting / Q000009:adverse effects / Q000502:physiology; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007508:Irritable Mood / Q000502:physiology; D008297:Male; D027845:Malus; D019637:Orthopedic Procedures; D011300:Preoperative Care; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D005947:Glucose