title: Risk factors for hyperketonemia in cleft lip and palate infants during general anesthesia.
abstract: OBJECTIVE
  The purpose of the present study was to investigate the risk factors for hyperketonemia with respect to patient age, the starting time of anesthesia (morning or afternoon), and the preoperative liquid intake when glucose was administered to infants before and during general anesthesia to avoid the hyperketonemia resulting from lipid catabolism.
  
  
  METHODS
  The subjects were 147 healthy infants, including 55 infants 2 to 6 months old (cleft lip group) and 92 who were 10 to 24 months old (cleft palate [CP] group). For preoperative liquid intake, the infants were allowed to drink formula or breast milk for ≤ 5 hours before entering the operating room and 6.7% glucose solution for ≤ 2 hours before entering the operating room. As an intraoperative infusion, 195 mg/kg/hour of glucose was constantly administered. The levels of blood ketone bodies and glucose were measured at anesthesia induction and 2 hours after induction. Blood ketone body (β-hydroxybutyrate) concentrations of ≥ 1.0 mmol/L were considered abnormally high.
  
  
  RESULTS
  The ketone body concentrations were abnormally high in 34 infants and normal in 113 infants. Significant differences were present in relation to age (P = .001) and age group (CP group, P < .001), and starting time of anesthesia (afternoon cases, P = .003). However, no difference in preoperative liquid intake was seen between groups. Logistic regression analysis suggested age group (CP group) and starting time of anesthesia (afternoon cases) as factors associated with elevated blood ketone body concentrations.
  
  
  CONCLUSIONS
  The risk factors for abnormally high ketone body concentrations were age group (CP group) and starting time of anesthesia (afternoon cases).
authors.affiliation: Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan. ysn-mori@dent.osaka-u.ac.jp
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Sugimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hanamoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Niwa
mesh_terms: D000367:Age Factors; D000766:Anesthesia, Dental / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D001784:Blood Gas Analysis; D001786:Blood Glucose / Q000032:analysis; D016009:Chi-Square Distribution; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D004326:Drinking; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007657:Ketone Bodies / Q000097:blood; D007662:Ketosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007657:Ketone Bodies; D005947:Glucose