Impact of preoperative fasting times on blood glucose concentration, ketone bodies and acid-base balance in children younger than 36 months: A prospective observational study.
BACKGROUND
In contrast to preoperative fasting guidelines in paediatric anaesthesia, actual fasting times are often too long.


OBJECTIVE
The objective of this study was to evaluate the effect of preoperative fasting on glucose concentration, ketone bodies and acid-base balance in children.


METHODS
A prospective, noninterventional, clinical observational study.


METHODS
A single-centre trial, study period from June 2014 to November 2014.


METHODS
One hundred children aged 0 to 36 months scheduled for elective paediatric surgery.


METHODS
Patient demographics, fasting times, haemodynamic data, glucose and ketone body concentrations, and acid-base parameters after induction of anaesthesia were documented using a standardised case report form.


RESULTS
Mean fasting period was 7.8 ± 4.5 (3.5 to 20) h, and deviation from guideline (ΔGL) was 3.3 ± 3.2 (-2 to 14) h. Linear regression showed a significant correlation between fasting times and ketone bodies, anion gap, base excess, osmolality as well as bicarbonate (for each, P < 0.05), but not glucose or lactate. In children with ΔGL more than 2 h (54%), ketone bodies, osmolality and anion gap were significantly higher and base excess significantly lower than children with ΔGL less than 2 h (for each, P < 0.05).


CONCLUSIONS
After prolonged preoperative fasting, children younger than 36 months can present with ketoacidosis and (low) normal blood glucose concentrations. Actual fasting times should be optimised according to existing guidelines. In small infants, deviations from fasting guidelines should be as short as possible and not longer than 2 h.
From the Clinic for Anaesthesiology and Intensive Care Medicine (ND, CB, DH, KN, BS, LHW, RS), and Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany (DB).
Nils
N
Dennhardt
Christiane
C
Beck
Dirk
D
Huber
Katja
K
Nickel
Björn
B
Sander
Lars-Henrik
LH
Witt
Dietmar
D
Boethig
Robert
R
Sümpelmann
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000136:Acid-Base Equilibrium / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D017558:Elective Surgical Procedures / Q000379:methods; D005215:Fasting / Q000097:blood; D007657:Ketone Bodies / Q000097:blood; D007662:Ketosis / Q000097:blood / Q000175:diagnosis; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies
D001786:Blood Glucose; D007657:Ketone Bodies