The Impact of Preoperative Fasting Duration on Blood Glucose and Hemodynamics in Children

The actual duration of preoperative fasting in pediatric patients, and its effects on hunger and thirst: a prospective observational study

BACKGROUND

Preoperative fasting time for food and clear liquid was recommended as 2 and 6 h to prevent pulmonary aspiration. Prolonged fasting led to ketosis, hypotension, and patient discomfort. This study aimed to investigate the actual duration of preoperative fasting in pediatric patients, its effects on hunger and thirst, and factors that influence hunger and thirst.

METHODS

This prospective observational study recruited participants aged 0-15 years who were scheduled for elective surgery or for other procedures to be performed under general anesthesia in a tertiary care center. All parents or participants were asked to report the fasting time for food and clear liquid. Participants aged 7-15 years self-rated their degree of hunger and thirst using a 0-10 scale. For participants aged less than 7 years, parents were asked to rate their child's degree of hunger based on the child's behavior. Dextrose-containing intravenous fluid administration and anesthesia start time were collected.

RESULTS

Three hundred and nine participants were included. The overall median [interquartile range; IQR] fasting duration for food and clear liquid was 11.1 h [IQR: 8.0, 14.0] and 10.0 h [IQR: 7.2, 12.5], respectively. The overall median hunger and thirst score was 7 [IQR: 5, 9] and 5 [IQR: 0, 7.5], respectively. High hunger score was reported in 76.4% of participants. There was no correlation between fasting time for food and hunger score [Spearman's rank correlation coefficient (Rho): -0.150, P=0.008], or between fasting time for clear liquid and thirst score (Rho: 0.007, P=0.955). Zero to 2-year-old participants had a significantly higher hunger score compared to older participants (P<0.001) and a higher proportion (80-90%) of high hunger score regardless of anesthesia start time. Although dextrose-containing fluid was administered ≥10 mL/kg, 85.7% of this group still reported high hunger score (P=0.008). Ninety percent of participants who had anesthesia start time after 12:00 PM reported high hunger score (P=0.044).

CONCLUSIONS

The actual duration of preoperative fasting was found to be longer than the recommendation for both food and liquid in pediatric surgical population. Younger age group and anesthesia start time in the afternoon were factors associated with high hunger score.

Preoperative Fasting Time and Its Association with Hypoglycemia during Anesthesia in Pediatric Patients Undergoing Elective Procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND

Preoperative fasting is important to reduce the risk of pulmonary aspiration during anesthesia. The influence of prolonged fasting time on glucose levels during anesthesia in children remains uncertain. Therefore, this study is aimed at assessing preoperative fasting time and its association with hypoglycemia during anesthesia in pediatric patients undergoing elective procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. The research hypothesis of the study is as follows: there is a prolonged preoperative fasting time, and it influences the glucose levels during anesthesia among pediatric patients undergoing elective procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

METHODS

Institutional based cross-sectional study was conducted among 258 pediatric patients who had undergone elective procedures in a tertiary care center. A systematic sampling method was used to select study participants. The data were collected through face-to-face interviews and medical record reviews. Binary logistic regression was used to identify associated factors of hypoglycemia during anesthesia among pediatric patients undergoing elective procedures. All explanatory variables with a p value of ≤0.25 from the bivariable logistic regression model were fitted into the multivariable logistic regression model to control the possible effect of confounders, and finally, the variables which had an independent association with hypoglycemia were identified based on adjusted odds ratio with 95% confidence interval, and a p value less than 0.05 was significant.

RESULTS

The mean (standard deviation) fasting hours from breast milk, solid foods, and clear fluids were 7.75 (2.89), 13.25 (3.14), and 12.31 (3.22), respectively. The majority (89.9%, 57.9%, and 100%) of participants had fasted from solid, breast milk, and clear fluids for more than 8, 6, and 4 hours, respectively. More than one-fourth (26.2%) of participants were hypoglycemic immediately after induction. Residence, order of nothing per mouth, source of patient, and duration of fasting from solid foods had a significant association with hypoglycemia during anesthesia in children.

CONCLUSION

Children undergoing elective procedures were exposed to unnecessarily long fasting times which were associated with hypoglycemia during anesthesia.