The Effect of Different Pre-Operative Feeding Regimens on Plasma Glucose and Gastric Volume and pH in Infancy

Abstract

The effects of four different pre-operative feeding regimens were studied in 123 children below the age of one year presenting for surgery. Plasma glucose concentrations, blood acid-base values, gastric volume and gastric pH were measured before and after induction of anaesthesia. No patient was found to be hypoglycaemic and there were no significant differences in plasma glucose concentration and acid-base values between the groups. No correlation was demonstrated between the age and weight of the patients and the duration of fasting and the plasma glucose concentration. There was a significant elevation of plasma glucose concentration in all four groups after induction of anaesthesia (P<0.001) compared with the pre-induction level which is a reflection of the stress of blood sampling and induction of anaesthesia. Infants less than three months of age in the milk-feed group had a significantly higher gastric volume with low pH (P<0.05) signifying a potentially greater risk of pulmonary acid aspiration. The practice of timing the last pre-operative feed in infancy according to the infant's normal feeding pattern does not appear to [ncrease the risk factors for pulmonary aspiration, if milk is avoided.

Intraoperative fluid and glucose management in children

“…(39). As a result of these ®ndings, it is suggested that hypoglycaemia may not be as common an occurrence in paediatric patients as was previously thought, even in infants below 1 year of age (38,41).…”

“…Thomas suggested that children below 47 months of age and 15.5 kg body weight were more susceptible to hypoglycaemia (31). Conversely, other studies found no increased incidence of hypoglycaemia in infants aged between 2 weeks and 22 months (38,41).…”

Safe pre‐operative fasting times after milk or clear fluid in childrenA preliminary study using real‐time ultrasound

“…Recommendations for milk often reflect those for solid food. Breast milk and infant milk formula have been said to be safe up to 4 h pre‐operatively [3] and cow's milk is not recommended as the last feed any later than 6 h before an operation [4, 5].…”

Aspiration Prevention and Prophylaxis

“…69 Splinter and colleagues found that healthy infants could drink clear liquids ad libitum until 2 hours before anesthetic induction without altering gastric fluid volume or pH. 69 Splinter and colleagues found that healthy infants could drink clear liquids ad libitum until 2 hours before anesthetic induction without altering gastric fluid volume or pH.…”