Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation

Abstract

Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of <10 as without ED at any time. The PAED scores were compared with other variables, ASA, age, weight, MRI examination time, and FBG level and fasting times. The risk factors affecting the occurrence of ED were examined. Results: Mean age was 3.94 ± 1.53 years, mean FBG was 106.97 ± 12.53 mg/dL, fasting time was 10.75 ± 2.61 h, solid food fasting time was 11.92 ± 2.33 h, and thirst time was 10.74 ± 2.58 h. FBG was never associated with PAED measurement at any time (p > 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p < 0.001, r = 0.357; p < 0.001, r = 0.345; p < 0.001, r = 0.360; p < 0.001, r = 0.240; p < 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.

Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study

“…In a previous study, fasting duration was associated with the incidences of ED at 15 and 20 min of recovery after ophthalmic examination [ 11 ]. Another study involving children who underwent procedural sedation for magnetic resonance imaging showed a relationship between fasting duration and ED incidence [ 10 ]. Compared with liquid fasting, solid fasting had a stronger association with increased ED rate.…”

“…Although it is brief, ED poses significant risks, including self-harm, drain removal, wound complications, pain exacerbation, and increased need for intensive care. Fasting status, patient age, surgical duration, and anesthesia type have been implicated in the onset of ED among children [ 10 , 11 ]. However, current research regarding the relationship between fasting status and ED is mainly focused on minor surgeries or procedural sedation, with limited evidence in major surgery.…”

Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives

“… 117 , 118 , 119 Prolonged preoperative fasting may be a risk factor for postoperative emergence delirium in children. 120 , 121 Optimised preoperative fasting management reduces fasting time, decreases ketone body concentration, and helps to stabilise mean arterial blood pressure during induction of anaesthesia in children. 122 , 123 …”