Association of NPO duration with glycemia in nondiabetic adolescents undergoing anesthesia for noncardiac surgery.

Abstract

Children and adolescents are required to fast prior to undergoing anesthesia to minimize the risk of pulmonary aspiration of gastric contents. Pre-operative fasting times vary, with longer fasts (8 hours) for solid foods and shorter fasts for clear liquids (1-2hours). Pediatric patients are more sensitive than adults to pre-operative fasting secondary to smaller glycogen stores and resultant propensity to ketoacidosis.1 Prolonged pre-operative fasting is associated with suboptimal perioperative outcomes including insulin resistance, hypotension upon induction, patient thirst and malaise, and postoperative nausea and vomiting.2 While prior studies have shown that children younger than 36 months can present with low-normal blood glucose (BG) levels after prolonged pre-operative fasting, no correlation between nil per os (NPO) duration and BG has been found.1 We sought to study this phenomenon of glycemia in older children and adolescents, hypothesizing that with full hepatic maturity and increased glycogen reserves, absence of correlation between NPO duration and BG levels would be upheld.