Optimized preoperative fasting times decrease ketone body concentration and stabilize mean arterial blood pressure during induction of anesthesia in children younger than 36 months: a prospective observational cohort study.
BACKGROUND
In pediatric anesthesia, preoperative fasting guidelines are still often exceeded.


OBJECTIVE
The objective of this noninterventional clinical observational cohort study was to evaluate the effect of an optimized preoperative fasting management (OPT) on glucose concentration, ketone bodies, acid-base balance, and change in mean arterial blood pressure (MAP) during induction of anesthesia in children.


METHODS
Children aged 0-36 months scheduled for elective surgery with OPT (n = 50) were compared with peers studied before optimizing preoperative fasting time (OLD) (n = 50) who were matched for weight, age, and height.


RESULTS
In children with OPT (n = 50), mean fasting time (6.0 ± 1.9 h vs 8.5 ± 3.5 h, P < 0.001), deviation from guideline (ΔGL) (1.2 ± 1.4 h vs 3.7 ± 3.1 h, P < 0.001, ΔGL>2 h 8% vs 70%), ketone bodies (0.2 ± 0.2 mmol·l(-1) vs 0.6 ± 0.6 mmol·l(-1) , P < 0.001), and incidence of hypotension (MAP <40 mmHg, 0 vs 5, P = 0.022) were statistically significantly lower and MAP after induction was statistically significantly higher (55.2 ± 9.5 mmHg vs 50.3 ± 9.8 mmHg, P = 0.015) as compared to children in the OLD (n = 50) group. Glucose, lactate, bicarbonate, base excess, and anion gap did not significantly differ.


CONCLUSIONS
Optimized fasting times improve the metabolic and hemodynamic condition during induction of anesthesia in children younger than 36 months of age.
Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
Nils
N
Dennhardt
Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
Christiane
C
Beck
Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
Dirk
D
Huber
Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
Bjoern
B
Sander
Clinic for Pediatric Cardiology and Pediatric Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
Martin
M
Boehne
Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Dietmar
D
Boethig
Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
Andreas
A
Leffler
Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
Robert
R
Sümpelmann
D000136:Acid-Base Equilibrium; D000758:Anesthesia; D062186:Arterial Pressure / Q000502:physiology*; D002675:Child, Preschool; D015331:Cohort Studies; D005215:Fasting / Q000502:physiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007657:Ketone Bodies / Q000097:blood*; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
D007657:Ketone Bodies
acid-base; blood pressure; children; fasting; glucose; ketone bodies