Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Br J Anaesth. 2018 Sep;121(3):656-661. doi: 10.1016/j.bja.2018.04.040. Epub 2018 Jun 8.
Preoperative fasting is a major cause of perioperative discomfort in paediatric anaesthesia and leads to postoperative insulin resistance, thus potentially enhancing the inflammatory response to surgery. Addressing these problems by preoperative carbohydrate intake has not been a well-defined approach in children.
We randomised 120 children scheduled for gastroscopy under general anaesthesia to either a control group of standard preoperative fasting or a study group receiving a carbohydrate beverage (PreOp™; Nutricia, Erlangen, Germany). Their stomach contents were aspirated endoscopically, and the volume and pH measured. Perioperative discomfort was evaluated using, among other parameters, an observational pain scale in ≤4-yr-olds and a VAS in >4-yr-olds. The investigators doing the endoscopies and outcome evaluations were blinded to the study group allocation.
Compared with fasting, carbohydrate loading was associated with significantly less gastric content (P=0.01), fewer patients experiencing postoperative nausea (P=0.028), with no significant difference in postoperative vomiting. High preoperative VAS scores (>5) were recorded for only one child in the carbohydrate group vs five children in the fasting group. Bowel cleansing for simultaneous colonoscopies (n=61) made no difference to any of the intergroup findings.
Preoperative carbohydrates can reduce nausea and gastric content, the latter being a surrogate parameter for the risk and severity of gastric aspiration into the lungs during anaesthesia. Our study adds knowledge for preoperative fasting guidelines in paediatric anaesthesia.
DRKS00005020.
术前禁食是小儿麻醉围手术期不适的主要原因，导致术后胰岛素抵抗，从而可能增强手术的炎症反应。通过术前碳水化合物摄入来解决这些问题在儿童中尚未得到明确界定。
我们将 120 名计划在全身麻醉下接受胃镜检查的儿童随机分为对照组（接受标准术前禁食）或研究组（接受碳水化合物饮料 PreOp™；Nutricia，德国埃朗根）。通过内镜抽吸他们的胃内容物，并测量其体积和 pH 值。使用包括≤4 岁儿童观察疼痛量表和>4 岁儿童视觉模拟评分（VAS）在内的其他参数评估围手术期不适。进行内镜检查和结局评估的研究人员对研究组分配不知情。
与禁食相比，碳水化合物负荷与胃内容物明显减少（P=0.01），术后恶心的患者明显减少（P=0.028），但术后呕吐无显著差异。仅在碳水化合物组的一名儿童中记录到高术前 VAS 评分（>5），而在禁食组的五名儿童中记录到该评分。同时进行结肠镜检查的肠道清洁（n=61）对任何组间发现均无影响。
术前碳水化合物可以减少恶心和胃内容物，后者是麻醉期间胃内容物吸入肺部的风险和严重程度的替代参数。我们的研究为小儿麻醉术前禁食指南提供了知识。
DRKS00005020。
