Benefícios metabólicos e inflamatórios da abreviação do jejum pré-operatório em cirurgia pediátrica

Abstract

Most current guidelines recommend a two-hour fastfor clear fluids before anesthesia, but these guidelinesare not being followed by pediatric hospitals,and several studies reportan excessive fasting time in these patients. Objectives: To investigate the metabolic and inflammatory effects, besides safety, of the reducing preoperative fasting time with carbohydrate-rich beverages to preschool children submitted to inguinal hernia repair.Methods: This is a prospective study enrolling 40 children randomized into two groups: fasting group –prescribed as “nil per os after midnight” and CHO group - children receiving a carbohydrate-rich beverage (maltodextrin 12,5%, 150ml) two hours before surgery. Blood samples were collected at pre and postoperativeperiods for dosages of albumin, interleukin 6, glucose, insulin and C-reactive protein (CRP), and the HOMA-IR index was calculated. Results: Preoperative fasting was significantly lower in CHO group (11:24h on fasting group vs 2:49h on CHO group, p<0,001). CRP levels were significantly lower on CHO group, both at preoperative (fasting group: 0.40 ± 2.35 mg/L vs CHO group: 0.25 ± 0.15 mg/L, p=0.05) and postoperativeperiods (fasting: 0.40 ± 2.25 mg/L vs CHO: 0.25 ±0.10 mg/L, p=0.02). The CRP/Albumin ratio was also significantly lower on CHO group at the preoperative period (fasting: 0.89 ± 1.86 vs CHO: 0.13± 0.15; p=0.03). Four (21%) patients from the fasting group became hyperglycemic preoperatively, whereas none had hyperglycemia on CHO group (p=0.04). There was no statistical difference on albumin, insulin and HOMA-IR index values. No adverse effectswere observed on this study. Conclusion: The abbreviation of preoperative fasting with carbohydrate-rich beverages is safe and improves the metabolic and inflammatory response to surgery trauma in preschool children who underwent elective inguinal hernia repair.