• Nils Dennhardt, Christiane Beck, Dirk Huber, Bjoern Sander, Martin Boehne, Dietmar Boethig, Andreas Leffler, and Robert Sümpelmann.
• Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
• Paediatr Anaesth. 2016 Aug 1; 26 (8): 838-43.

BackgroundIn pediatric anesthesia, preoperative fasting guidelines are still often exceeded.ObjectiveThe 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.MethodsChildren 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.ResultsIn 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 (ΔGL) (1.2 ± 1.4 h vs 3.7 ± 3.1 h, P < 0.001, ΔGL>2 h 8% vs 70%), ketone bodies (0.2 ± 0.2 mmol·l(-1) vs 0.6 ± 0.6 mmol·l(-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.ConclusionOptimized fasting times improve the metabolic and hemodynamic condition during induction of anesthesia in children younger than 36 months of age.© 2016 John Wiley & Sons Ltd.

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