Optimized preoperative fasting times decrease ketone body concentration and stabilize mean arterial blood pressure during induction of anesthesia in children younger than 36 months: a prospective observational cohort study

Background: In pediatric anesthesia, preoperative fasting guidelines are still often exceeded. Objective: The objective of this noninterventional clinical observational cohort study was to evaluate the effect of an optimized preoperative fasting management (OPT) on glucose concentration, ketone bodies, acid-base balance, and change in mean arterial blood pressure (MAP) during induction of anesthesia in children. Methods: Children aged 0-36 months scheduled for elective surgery with OPT (n = 50) were compared with peers studied before optimizing preoperative fasting time (OLD) (n = 50) who were matched for weight, age, and height. Results: In children with OPT (n = 50), mean fasting time (6.0 1.9 h vs 8.5 +/- 3.5 h, P < 0.001), deviation from guideline (GL) (1.2 +/- 1.4 h vs 3.7 +/- 3.1 h, P < 0.001, GL>2 h 8% vs 70%), ketone bodies (0.2 +/- 0.2 mmoll(-1) vs 0.6 +/- 0.6 mmoll(-1), P < 0.001), and incidence of hypotension (MAP <40 mmHg, 0 vs 5, P = 0.022) were statistically significantly lower and MAP after induction was statistically significantly higher (55.2 +/- 9.5 mmHg vs 50.3 +/- 9.8 mmHg, P = 0.015) as compared to children in the OLD (n = 50) group. Glucose, lactate, bicarbonate, base excess, and anion gap did not significantly differ. Conclusion: Optimized fasting times improve the metabolic and hemodynamic condition during induction of anesthesia in children younger than 36 months of age.