The Association Between Preoperative Fasting Time, Blood Glucose Concentration and Blood Ketone Levels in Pediatric Patients Undergoing Surgical Procedures at the Kenyatta National Hospital

Abstract

Background/Introduction: Preoperative fasting guidelines have been updated to ensure the risk of paediatric patients developing hypoglycaemia, ketoacidosis, and derangement in acidbase balance during the preoperative fasting period is reduced since they are unable to properly regulate glucose metabolism due to their anatomical and physiologic differences when compared to adults. However, challenges at resource limited, high-volume centers such as the Kenyatta National Hospital (KNH), have led to inefficient implementation of the preoperative fasting recommendations. Objective: to determine the association between preoperative fasting time, blood glucose concentration and blood ketone levels in pediatric patients undergoing surgical procedures at the National Hospital. Methods: an analytical cross-sectional study conducted at the Kenyatta National Hospital main theatres, the ophthalmology and ENT satellite theatres involving two hundred and twenty-two (222) paediatric patients aged 0-13 years who met the inclusion criteria. Consenting paediatric patients were recruited on the eve and day of surgery and blood samples of 0.5 microlitre collected from the fingertip or heel at induction of anaesthesia. Blood glucose and ketone levels were measured using POC handheld Abbott Freestyle Optimum Neo combined glucose and ketone meter. Statistical analyses were performed using SPSS version 26 and Pearson’s correlation was used to determine the strength and direction of the associations with statistical significance tested at 5% (p-value ≤ 0.05). Results: The overall median fasting time was 11.0 (IQR 7-14) hours with 218 (98.2%) deviating from the preoperative fasting guidelines. There was hypoglycaemia in 65 (29.3%) patients and high ketone levels in 92 (41.4%) of the patients. The study found poor correlation between preoperative fasting time and blood glucose level which was statistically significant (r = -0.190, p =0.04) and a poor correlation between preoperative fasting time and blood ketone levels which was not statistically significant (r= -0.086, p= 0.202). There was also poor association between age, weight gender and types of last meal and the glucose level at induction of anaesthesia. Conclusion: there was prolonged preoperative fasting time and marked deviation from current documented preoperative fasting guidelines among paediatric patients at the Kenyatta National Hospital. The correlation between preoperative fasting time and blood glucose concentration and blood ketone levels was not strong however it is clinically significant as it impacts perioperative outcomes