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• W2892568862 abstract "INTRODUCTION :Preoperative fasting is the practice that requires a patient to be nil per oral (refrain from oral food andliquid intake) for a pre determined period of time prior to a surgical procedure. This is aimed at preventing the regurgitation of stomach contents which in turn can lead to pulmonary aspiration during general anesthesia.It must however be kept in mind that fasting patients for longer than the optimum period can be detrimental to their health especially in children and specifically those in the younger age. However studies as well as common knowledge suggests that overfasting is indeed a frequent practice. This problem of “over fasting” is mainly secondary to the practical difficulties associated with running a theatre list like unforeseen rescheduling and cancellation or addition of procedures which inevitably lead to skewed fasting times.In this study we have evaluated two hypothesis. Firstly whether hypoglycemia plays a part in such children who have for various reasons been fasting for longer than required and if routine measurements of blood sugar levels are required prior to surgical procedures. Though there have been studies done to assess the association between prolonged fasting and hypoglycaemia these have been on other population groups. Studies on our population group have been few and inconclusive. Hence there was a need to carry out a study with a sufficiently large sample size to establish a causal relationship between the two if any. The other hypothesis is that the duration of pre operative fasting may be a significant contributor in prolonging the recovery of a child in the early postoperative period. Efforts to support this hypothesis have mostly been based on anecdotal evidence. We aim to determine if there is a time limit within which these factors play a role, if changes need to be made in routine pre operative practices in our hospital, and if further investigations and/or interventions need to be planned.AIM OF THE STUDY:The aim of this study was to evaluate the incidence of hypoglycemia in children under the age of fiveundergoing elective surgical procedures at the time of induction.OBJECTIVES:1. To determine the correlation between preoperative fasting duration and fasting plasma glucose levels.2. To evaluate the correlation between pre operative fasting and post operative awakening time.METHODOLOGY:After approval of the topic and design from the department a small pilot study was conducted on 5 patients. Subsequent to the pilot study protocols were refined after which the proposal wassubmitted to the institutional review board and ethics committee. Proposals regarding the studywere also submitted to the department of pediatric surgery and the department of clinicalbiochemistry . After due approval and funding was secured from all of the aforementioned, the studywas initiated in our department. Inclusion Criteria:1. Paediatric surgery patients coming for elective procedures.2. Age between 1 to 60 months.3. ASA grade 1 & 2.Exclusion Criteria:1. Children with known Metabolic syndromes.2. Refusal of consent.3. Emergency surgical procedures.Setting Of the Study:The study was carried out under the Department of Anaesthesiology, Christian Medical College, Vellore in the Centenary building Operating Theatre complex. The subjects were taken from among patients coming for elective surgery under the Department of Paediatric Surgery.Study Design:The study was designed to be a prospective, single blinded observational study.Blinding and Masking:Since this was an observational study we were unable to perform a double blinding. Any other study design would have not passed the scrutiny of the ethics committee of the institution.Outcomes:Primary Outcome:Blood sugar levels as measured at the time of induction of anaesthesia.Secondary Outcomes:Delayed awakening due to hypoglycemia at the end of the operative procedure.STATISTICAL ANALYSIS :Patients were grouped by duration of preoperative fast (0–4 h, 4–8 h, 8–12 h, and >12 h). The incidence of hypoglycemia were presented along with its respective confidence interval. The relationship between the fasting time before surgery, age and weight, and the plasma glucose levels were assessed using a multiple regression model after assessing their relationship at the univariate level with t-tests and chi-square tests.Receiver operating characteristic (ROC) curve were used to determine the optimal cut-point for fastingtime to be screened for potential hypoglycemia. Means and standard deviations were then used to describe demographic data and secondary outcomes. Within each age group, the HR, SAP, and MAP data (baseline values, 1.5 MAC values, and absolute changes from baseline to 1.5 MAC values) were also compared among fasting groups by using one-way analysis of variance, followed post hoc by Fisher’s protected least significant difference test for multiple means comparisons.Logistic regression analysis were then used to correlate the duration of fasting with the change in SAP, MAP and HR within each age group. P < 0.05 were considered to be statistically significant. Logistic regression analysis was done to assess the correlation between duration of fasting for liquids and solids. Similar methods were also used to correlate other variable data.CONCLUSIONS :In this study evaluating the effects of pre operative fasting in children under the age of 60 months on blood sugar levels at induction as well as its role in delayed awakening we reached the following conclusions :1. Fasting in children though detrimental in more ways than one did not cause hypoglycemia even whenfasting longer than expected. Routine measurement of blood glucose levels in otherwise healthy childrenis therefore not warranted.2. As none of the children who fasted for longer than 12 hours developed hypoglycemia we can safely assume that there is no link between pre operative fasting and duration to awakening attributable to pre op glucose levels.3. Delayed awakening in children without a co existing metabolic disorder is unlikely to be due tohypoglycemia.4. Almost one in five children had fasted for longer than 12 hours and though the duration did not affectfasting blood sugar levels, other side effects were observed in the children.To summarize, prolonged fasting does not lead to hypoglycemia prior to induction nor does it lead todelayed awakening secondary to hypoglycemia in otherwise healthy children below the age of 60months." @default.
• W2892568862 created "2018-10-05" @default.
• W2892568862 creator A5090313429 @default.
• W2892568862 date "2013-04-01" @default.
• W2892568862 modified "2023-09-26" @default.
• W2892568862 title "The Evaluation of the incidence of hypoglycemia at Induction in Children under the age of Five Undergoing Elective Surgical Procedures: A Prospective, Single-Blinded, Observational study" @default.
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