Plasma glucose levels in the peri‐operative period in children

Summary Two hundred healthy, unpremedicated children, ages 1–10 years, scheduled for elective outpatient surgery were studied in order to examine the effect of minimizing preoperative fasting on perioperative blood glucose concentrations in paediatric patients. None of the patients ingested solids after midnight. On the day of surgery, the children were assigned to one of two groups. Group A children (n= 113) were not allowed any liquids for at least 6 h prior to surgery (NPO). Children in Group B (n= 87) ingested 10 ml·kg−1 of apple juice 2–4 h prior to the induction of anaesthesia. All patients received lactated Ringer's solution intraoperatively, unless BG at induction was < 50 mg·dl−1 (2.8 m·mol·l−1) in which case dextrose 2.5% in lactated Ringer's solution was administered. None of the patients who received apple juice was hypoglycaemic during induction of anaesthesia. However, two children in the NPO group had blood glucose values ± 50 mg·dl−1 (2.8 m·mol·l−1) at the time of induction of anaesthesia. Thirteen (11%) patients in Group A and 6 (7%) patients in Group B showed either no change or a further decrease in their postoperative BG concentration as compared with their induction values. Two of 43 patients in Group A and 2 of 41 patients in Group B had gastric fluid volumes > 0.4 ml/kg. All patients in both groups had gastric pH < 2.5. This study shows that gastric fluid volume and pH following a 2–4 h fast are not different from the values measured in children who were subjected to a traditional fasting period of 6 h or longer. Moreover, apple juice consumed 2–4 h prior to surgery neither buffers gastric pH nor does it modify intraoperative glucose homeostasis in children.

Section: Introductionmentioning

confidence: 99%

Effect of minimizing preoperative fasting on perioperative blood glucose homeostasis in children

Welborn

Norden

Seiden

et al. 1993

“…Whether these small doses are sufficient to achieve a faster postoperative normalization of the blood glucose concentration in children remains to be studied. Preoperative hypoglycaemia has been described, particularly after prolonged preoperative starvation and in malnourished children (Thomas 1974;Payne & Ireland 1984;Welborn et al 1986Welborn et al , 1993. We found no cases of hypoglycaemia preopera tively.…”

Section: ~ ~~mentioning

confidence: 39%

“…Two h after minor surgery most children were capable of oral intake. Hypoglycaemia has however been reported at three h after surgery in children without glucose perioperatively (Payne & Ireland 1984).…”

Section: ~ ~~mentioning

confidence: 99%

Four different fluid regimes during and after minor paediatric surgery—a study of blood glucose concentrations

Sandström¹,

Larsson²,

Nilsson³

1994

Summa yIn order to evaluate the efficiency of glucose homeostatic mechanisms in otherwise healthy infants and children during and after anaesthesia and surgery four different fluid regimes were studied in 40 patients, 6-24 months old. The four regimes all resulted in a total fluid volume of 10 ml-kg-'-h-' intraoperatively and 3 mi-kg-' h-' postoperatively. One group received a combination of glucose 300 mgkg-'.h-' and Ringer acetate intraoperatively and glucose postoperatively, a second group was given the same intraoperative fluid followed by glucose free Ringer acetate postoperatively. A third group received Ringer acetate both intra-and postoperatively and a fourth group was given Ringer acetate intraoperatively and glucose postoperatively. Blood glucose concentrations were measured after induction (Preop.), immediately after surgery (Postop.) and after 30, 60 and 120 min. Increased blood glucose concentrations were found in all children immediately after surgery. The concentrations were highest among children given glucose. Postoperatively blood glucose remained elevated in children receiving glucose after surgery. In patients without postoperative glucose supply blood glucose concentrations declined. Hypoglycaemia was not seen on any occasion. The differences in blood glucose concentrations with different regimes were significant but small. We conclude that the studied group of healthy children appeared to be capable of regulating blood glucose levels within normal limits with or without intraoperative glucose and also if the intraoperative glucose supply was interrupted postoperatively.

“…Neonates are also at risk of hypoglycaemia during surgery, particularly if glucose solutions have been given pre-operatively and are interrupted intraoperatively (Larsson et al 1990). Conversely, the risk of pre-operative hypoglycaemia has been demonstrated to be very low in normal healthy infants and children (1 to 2%), despite prolonged fasting periods (Jensen, Wemberg & Andersen 1982;Nilsson et al 1984;Payne & Ireland 1984;Srinivasan et al 1986;Welbornet al 1986Welbornet al ,1987Aun & Panesar 1990). There is, however, no agreement in the literature regarding ..…”

Section: Discussionmentioning

confidence: 99%

Evaluation of current paediatric guidelines for fluid therapy using two different dextrose hydrating solutions

Hongnat

Murat

Saint-Maurice

1991

Summa ySimplified guidelines for intra-operative fluid therapy were evaluated in two groups of children (aged 3 months-10 years) undergoing minor non-haemorrhagic surgical procedures, randomly assigned to receive either 5% or 2.5% dextrose in 0.3% or 0.4% normal (N) saline. Blood samples were obtained at the time of induction and upon arrival in the recovery room. Fasting time was on average greater than 10 h and hypoglycaemia, defined as blood glucose less than 3.5 mmol-1-l, was observed in 7.4% of the children at the time of induction. In both groups, blood glucose increased at the end of surgery, this increase being more significant in children receiving 5% dextrose than in those receiving 2.5% dextrose. In both groups, post-operative blood glucose values were higher in children of less than 4 years of age than in those aged 4 and over. Blood glucose changes were associated with a decrease in plasma sodium, this decrease being greater in chiIdren receiving 5% dextrose in 0.3 N saline, especially in those less than 4 years of age. This study suggests that the use of a 5% dextrose hydrating solution in 0.3 N saline is more likely to result in hyperglycaemia and hyponatraemia than a 2.5% dextrose in a 0.4 N saline, particularly in children younger than 4 years of age.