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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
Author(s) -
Dennhardt Nils,
Beck Christiane,
Huber Dirk,
Sander Bjoern,
Boehne Martin,
Boethig Dietmar,
Leffler Andreas,
Sümpelmann Robert
Publication year - 2016
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12943
Subject(s) - medicine , preoperative fasting , anesthesia , hemodynamics , blood pressure , cohort , mean arterial pressure , prospective cohort study , ketone bodies , heart rate , metabolism , perioperative
Summary 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 (Δ GL ) (1.2 ± 1.4 h vs 3.7 ± 3.1 h, P < 0.001, Δ GL >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. Conclusion Optimized fasting times improve the metabolic and hemodynamic condition during induction of anesthesia in children younger than 36 months of age.