Effect of Preoperative Fasting Duration on Blood Glucose and Hemodynamics in Pediatric Patients

Background: Preoperative fasting is essential to reduce the risk of pulmonary aspiration during anesthesia. However, prolonged fasting in pediatric patients may lead to hypoglycemia, dehydration, and hemodynamic instability. This study aimed to evaluate the effect of preoperative fasting duration on blood glucose levels and hemodynamic parameters in children undergoing elective surgery.

Methods: A hospital-based, observational case–control study was conducted at Yadgir Institute of Medical Sciences from April 1, 2025, to August 31, 2025. Fifty pediatric patients (aged 1–12 years) scheduled for elective surgery under general anesthesia were enrolled and divided into two groups: Group A (standard fasting; n=25) and Group B (prolonged fasting; n=25). Preoperative blood glucose and intraoperative hemodynamic parameters—heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)—were recorded at baseline, after induction, and at 5-minute intervals during the first 15 minutes of surgery. Statistical analysis was performed using SPSS 21, with p<0.05 considered significant.

Results: The mean preoperative blood glucose was significantly lower in Group B (83.6 ± 9.8 mg/dL) compared to Group A (95.2 ± 10.5 mg/dL; p=0.002). Prolonged fasting was associated with higher HR (peak 114 ± 16 bpm vs. 105 ± 15 bpm; p=0.04) and more frequent MAP decreases >15% from baseline (9/25 vs. 2/25; p=0.008). Systolic and diastolic blood pressures were slightly lower in the prolonged fasting group during induction and the early intraoperative period.

Conclusion: Prolonged preoperative fasting in pediatric patients leads to reduced blood glucose and significant hemodynamic changes. Adherence to evidence-based fasting guidelines, allowing clear fluids up to 2 hours preoperatively, is crucial to maintain metabolic stability and hemodynamic equilibrium, thereby improving perioperative safety and comfort.