Purpose: The purpose of the present study was to investigate the risk factors for hyperketonemia with respect to patient age, the starting time of anesthesia (morning or afternoon), and the preoperative liquid intake when glucose was administered to infants before and during general anesthesia to avoid the hyperketonemia resulting from lipid catabolism.
Patients and methods: The subjects were 147 healthy infants, including 55 infants 2 to 6 months old (cleft lip group) and 92 who were 10 to 24 months old (cleft palate [CP] group). For preoperative liquid intake, the infants were allowed to drink formula or breast milk for ≤ 5 hours before entering the operating room and 6.7% glucose solution for ≤ 2 hours before entering the operating room. As an intraoperative infusion, 195 mg/kg/hour of glucose was constantly administered. The levels of blood ketone bodies and glucose were measured at anesthesia induction and 2 hours after induction. Blood ketone body (β-hydroxybutyrate) concentrations of ≥ 1.0 mmol/L were considered abnormally high.
Results: The ketone body concentrations were abnormally high in 34 infants and normal in 113 infants. Significant differences were present in relation to age (P = .001) and age group (CP group, P < .001), and starting time of anesthesia (afternoon cases, P = .003). However, no difference in preoperative liquid intake was seen between groups. Logistic regression analysis suggested age group (CP group) and starting time of anesthesia (afternoon cases) as factors associated with elevated blood ketone body concentrations.
Conclusions: The risk factors for abnormally high ketone body concentrations were age group (CP group) and starting time of anesthesia (afternoon cases).
Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.