Perioperative blood glucose in a paediatric daycase facility: Effects of fasting and maintenance fluid

Abstract

Most children undergoing ambulatory surgery at our facility are still exposed to prolonged fasting time. Glucose containing fluid often administered as maintenance fluid to treat the presumed hypoglycaemia causes worsening hyperglycaemia, which may be harmful.

Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward

“…Due to the concern regarding aspiration, most fasting guidelines suggest a 6,4,2 rule (6 hours of starvation for food, 4 hours for breast milk, and 2 hours for clear fluids) despite the lack of evidence that a 2‐hour clear fluid fast is necessary. The literature supports the view that a 2‐hour clear fluid fasting policy, even when proactively managed results in an actual fasting time of between 6 and 13 hours …”

“…If a 2‐hour clear fluid fasting policy translated into even a 4‐hour fast, the process would be much more bearable. However, it is clear both from the literature and from our own data that such a policy, at best, results in a 6‐7 hours fast even with a pro‐actively managed list . Our single biggest improvement came from a change to a 1‐hour clear fluid fasting policy that in turn allowed for the offer of a clear fluid drink on arrival.…”

Effect of using ringer's lactate, with and without addition of dextrose, on intra-operative blood sugar levels in infants undergoing facial cleft surgeries

“…Observation that glucose containing fluids administered as maintenance fluid to treat presumed hypoglycemia actually caused worsening of hyperglycemia was made by Adenekan AT[ 13 ] but the age group studied by them was in the range of 3 months to 15 years and the two fluids compared were Ringer's acetate and 4.3% glucose. Some studies do advocate the use of dextrose in the intraoperative fluid to avoid hypoglycemia, but the concentrations of dextrose seem to vary.…”

Perioperative blood glucose, fasting and maintenance fluid

“…The report on ‘perioperative blood glucose, fasting and maintenance fluid’[ 1 ] is very interesting. Adenekan noted ‘the commonly administered 4.3% dextrose in 0.18% saline (DS) to treat the presumed hypoglycaemia often causes severe hyperglycaemia, which is known to have negative impact on outcome of surgery’.…”

“…Adenekan noted ‘the commonly administered 4.3% dextrose in 0.18% saline (DS) to treat the presumed hypoglycaemia often causes severe hyperglycaemia, which is known to have negative impact on outcome of surgery’. [ 1 ] In fact, to manage the glucose homeostasis is a very difficult issue in paediatric surgery. In general surgery, the use of alternative option to glucose maintenance fluid is also studied.…”