The Period of Operation and Perioperative Blood Glucose Concentration in Children any Change from the last two Decades?

Abstract

Glucose is the metabolic fuel for most tissues in the body while other substrates such as lactate and ketone bodies become important during starvation. The metabolic changes during starvation function to preserve glucose and the limited reserves of glycogen in the liver for use by the brain and the erythrocytes, liver glycogen therefore is largely intended for maintenance of blood glucose concentrations in between meals.(1) Inadequate glycogen stores and immature enzyme systems in neonates and infants when exposed to prolonged fasting periods may predispose to hypoglycaemia preoperatively. Hyperglycaemia may also occur particularly when these infants are given intravenous glucose.(2) In a developing country several factors combine to cause delay in starting surgery. it extends the fasting period and may adversely affect the blood glucose levels in children. This was a prospective observational study of preoperative blood glucose levels in 90 consecutive ASA 1 and 2 children aged 1-12 years scheduled for various elective surgeries. All the children were premedicated 1-2h before surgery with oral promethazine. Demographic data as well as duration of fast was obtained, blood glucose level was estimated by One touch glucometer (Life Scan Inc. USA) immediately after induction. The mean age of the children was 4.1±2.6 yr and the mean weight was 15.9±6.2 kg. The mean duration of preoperative fast was 13.1±4.2 h (5-23) h. The incidence of hypoglycaemia was 13.3%. Duration of fast did not significantly correlate with the occurrence of hypoglycaemia (p=0.41). There was a significant difference between the mean fasting blood glucose concentration of children who had morning surgery (4.7±1.2)mmoUL and those who had afternoon surgery (4.4±1.1) mmoi/L (p=0.02). This study has shown that fasting blood glucose was significantly influenced by period of surgery; children operated in the morning had significantly higher blood glucose levels than those operated in the afternoon.

Keywords: perioperative hyperglycaemia; hypoglycaemia; blood glucose; operation