title: Pediatric patients on ketogenic diet undergoing general anesthesia-a medical record review.
abstract: OBJECTIVE
  To identify guidelines for anesthesia management and determine whether general anesthesia is safe for pediatric patients on ketogenic diet (KD).
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Postoperative recovery area.
  
  
  METHODS
  All pediatric patients who underwent general anesthesia while on KD between 2009 and 2014 were reviewed. We identified 24 patients who underwent a total of 33 procedures. All children were on KD due to intractable epilepsy. The age of patients ranged from 1 to 15 years.
  
  
  METHODS
  General anesthesia for the scheduled procedures.
  
  
  METHODS
  Patients' demographics, seizure history, type of procedure; perioperative blood chemistry, medications including the anesthesia administered, and postoperative complications.
  
  
  RESULTS
  Twenty-four patients underwent a total of 33 procedures. The duration of KD treatment at the time of general anesthesia ranged from 4 days to 8 years. Among the 33 procedures, 3 patients had complications that could be attributable to KD and general anesthesia. A 9-year-old patient experienced increased seizures on postoperative day 0. An 8-year-old patient with hydropcephalus developed metabolic acidosis on postoperative day 1, and a 7-year-old patient's procedure was complicated by respiratory distress and increased seizure activity in the postanesthesia care unit.
  
  
  CONCLUSIONS
  This study showed that it is relatively safe for children on KD to undergo general anesthesia. The 3 complications attributable to general anesthesia were mild, and the increased seizure frequencies in 2 patients returned back to baseline in 24 hours. Although normal saline is considered more beneficial than lactated Ringer's solution in patients on KD, normal saline should also be administered carefully because of the risk of exacerbating patients' metabolic acidosis. One should be aware of the potential change of the ketogenic status due to drugs given intraoperatively.
authors.affiliation: Pediatric Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97539, USA. Electronic address: soysale@outlook.com.
authors.forename: Elif
authors.initials: E
authors.lastname: Soysal
authors.affiliation: Anesthesia, Pediatrics, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97539, USA.
authors.forename: Heike
authors.initials: H
authors.lastname: Gries
authors.affiliation: Pediatric Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97539, USA.
authors.forename: Carter
authors.initials: C
authors.lastname: Wray
mesh_terms: D000138:Acidosis / Q000139:chemically induced; D000293:Adolescent; D000768:Anesthesia, General / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D055423:Diet, Ketogenic / Q000009:adverse effects*; D004827:Epilepsy / Q000178:diet therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008499:Medical Records; D011183:Postoperative Complications / Q000209:etiology*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D000077325:Ringer's Lactate; D012640:Seizures / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate
keywords: Anesthesia; General; Ketogenic diet; Ketosis; Postoperative complications