| Summary: | Background: Children have historically been fasted for prolonged periods
preoperatively to reduce the volume and acidity of their gastric contents and thus
the risk of regurgitation and pulmonary aspiration. Evidence shows that this risk
is not increased by following the current recommended fasting guidelines, and
that prolonged fasting may be detrimental to children, who may present with
hunger, thirst, depleted intravascular volume, metabolic acidosis and
hypoglycaemia.
A recent study at Charlotte Maxeke Johannesburg Academic Hospital showed a
18.5% prevalence of biochemical hypoglycaemia, defined as a blood glucose
concentration of less than 3.5 mmol/l, in children from one to five years of age
presenting for elective surgery.
Aims: The aims of this study were to document the prevalence of biochemical
hypoglycaemia in children from the ages of one to five years who were given
apple juice to drink at least two hours preoperatively, and to compare these
results to a historical control group.
Methods: A prospective, contextual comparative study design was used.
Approval was obtained from the University of the Witwatersrandʼs Human Ethics
Committee and other relevant authorities.
The groups were matched for age and weight. Consent was obtained from the
guardians of all children who met the inclusion criteria before being enrolled in
the study.
A standard 200 ml carton of commercially available apple juice was offered to
each participant. The volume and time of the juice consumed was documented,
along with relevant demographic data. Inhalational induction of anaesthesia proceeded a minimum of two hours later, and a venous glucose concentration
was measured.
Results: The prevalence of biochemical hypoglycaemia was statistically
significantly reduced in the intervention group (p = 0.0163), eliminating the effect
of prolonged preoperative fasting.
Conclusion: The consumption of clear apple juice on the morning of surgery is a
safe, inexpensive, effective way to reduce the prevalence of hypoglycaemia in
children presenting for elective surgery.
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