Blood glucose concentrations were measured in 104 children aged 6 months- 10 years (mean 3.1 years) undergoing inpatient anaesthesia.
Pediatricians and anaesthesiologists are concerned about the long period of pre-operative starvation in children. Children undergoing elective surgery for hernia repair, strabismus and tonsillectomy were included in the study. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community.
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Prolonged fasting is expected to result in sig­nificant hypoglycaemia with resultant deleterious effects on the still maturing brain.
The routine schedule of pre-operative fasting starting from the midnight before the operation was followed. Today I checked my hba1c result is 5.2% but am urinating 10 times in a day which quite difficult for me.
Alba, What would be the glucose reaction if I eat 2 scrambled eggs with 2 slices of salt-cured bacon and one slice of wholegrain toast? Preoperative starvation and plasma glucose con­centration, in children undergoing outpatient anaesthesia.

Our results are therefore different from the prevalence of 28% hypoglycaemia in less than 2 years old reported by Thomas1 and 10% in less than 15 years old2. Preoperative star­vation and blood glucose concentration, in children undergoing inpatient and out-patient anaesthesia. Intravenous glucose tolerance in the normal newborn infant; the effect of a double dose of glucose and insulin. Post-anaesthetic increase in blood glucose level was the same as reported in adults (JPMA 40 : 243, 1990).
Blood samples for glucose level were taken before and 30 minutes after induction of anaesthesia. Mubaraka Naseer of PMRC Research Centre for the statistical analysis, labora­tory work and secretarial assistance respectively is ac­knowledged with appreciation. An increase in post-anaesthetic blood sugar level owing to the stress of anaesthesia and surgery is well documented5,6. Our children are continually stressed by recurrent episo­des Of illness especially in the first two years of life.
Pre-anaesthetic fasting blood glucose level is also expected to vary according to age of patient, period of fasting, time to operation and the premedication given. Blood glucose level was estimated by the method of Cooper and McDaniell7, in which orthotoluidine reacts quantitatively with the aldehyde group of the aldohcxoses to form a glycosylamine and schiff base. A child has on an average 6-7 episodes of diarrhoea and about the same number of respiratory infections in this period. In future it would be appropriate to look at the nutritional status, disease history and cortisol levels of children as well. In Pakistan prolonged pre-anaesthetic fasting of children is common, owing mainly to the long operation lists of surgeons.

Our subjects were not given effective preoperative sedation which would also contribute to the stress of hospital admission, stay in an unfamiliar environment and the fear of injections and operation. No data is available on the prevalence of hypoglycaemia in our children whose response to fasting may be modified by the additional factors of chronic malnutrition and recurrent gastrointestinal and respira­tory infections. One interesting reason given for differences in prevalence of hypoglycaemia in different studies is the diurnal variation in blood glucose level. The studies of Thomas1 and Graham3 which were carried out in the same hospital had different prevalence. The reported reason was the different timings of the operations; one study was in the morning and the other in the afternoon. It was suggested that overnight fasting is not as deleterious as day time fasting with regard to blood sugar level. The lack of correlation between period offastingand blood glucose level and age and blood glucose level in our study is similar to that of others2-4. The study of a larger number of subjects is needed however before any con­clusions can be reached. The increase in blood glucose level during surgery seen in our subjects and reported in adults by others5,6 is attributed to a state of glucose intolerance and insulin suppression. Since our study was on a limited number of children and hormonal levels could not be done we can only tentatively conclude that hypoglycaemia is not a real problem of our children subjected to prolonged pre­operative fasting. We suggest more comprehensive studies with larger number of subjects on this interesting and important subject.

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    Need to be controlling carb intake because carbs organizations, including the American Diabetes Association (ADA.

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