PP259-SUN: Outstanding abstract: Assessment of Tolerance and Metabolic Effects of Preoperative Oral Carbohydrate Solution in Children

2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration—A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting *

“…The body of evidence included 139 studies (adult surgical: 99 randomized controlled trials, 23–34,36–64,68–86,91,118–157 7 nonrandomized trials, 65,66,87,152,158–160 3 prospective cohort studies, 90,161,162 2 retrospective cohort studies, 163,164 1 case-control study, 165 and 2 before–after studies 67,166 ; adult nonsurgical: 1 randomized controlled trial, 167 9 crossover, 168–176 and 2 nonrandomized trials 177,178 ; pediatric surgical: 9 randomized controlled trials, 100,113,179–185 1 prospective cohort 186 ; and pediatric nonsurgical: 2 randomized controlled trial, 102,104 1 crossover, 35 and 1 prospective cohort 103 ) comparing carbohydrate-containing clear liquids (simple, complex) with water, placebo, or fasting. In the carbohydrate arms, liquids were allowed an average of 2.25 h before surgery (80% until 2 h).…”

A review of pediatric fasting guidelines and strategies to help children manage preoperative fasting

“…They found these drinks to be well tolerated and did not report any cases of aspiration in the small cohort 45 . They also found that insulin resistance (calculated using the Homeostatic Model Assessment for Insulin Resistance [HOMA‐IR] equation) was higher in the standard fast group (2.0 [0.43–7.55] vs 0.62 [0.37–2.22], p = .03) 45 …”

“…The use of carbohydrate drinks in the pediatric population has been less well investigated. From the limited available evidence, they appear safe in children, are well tolerated, and do not seem to increase aspiration risk during anesthesia; they are however not yet used routinely in the preoperative preparation of children 45,46 . The varied metabolic stress response in children means the standard carbohydrate‐rich drinks may not result in the same outcomes as noted in the adult population; but they may confer the same benefit of reduced insulin resistance 45 …”

“…A RCT of 20 children aged 4–17 years with ASA I or II classifications, compared a 12.6% carbohydrate solution given the evening prior and again 2 h preoperatively, against a standard fast 45 . They found these drinks to be well tolerated and did not report any cases of aspiration in the small cohort 45 .…”

“…A RCT of 20 children aged 4–17 years with ASA I or II classifications, compared a 12.6% carbohydrate solution given the evening prior and again 2 h preoperatively, against a standard fast 45 . They found these drinks to be well tolerated and did not report any cases of aspiration in the small cohort 45 . They also found that insulin resistance (calculated using the Homeostatic Model Assessment for Insulin Resistance [HOMA‐IR] equation) was higher in the standard fast group (2.0 [0.43–7.55] vs 0.62 [0.37–2.22], p = .03) 45 …”