ABSTRACT : TO HIGHLIGHT THE IMPORTANCE OF PERIOPERATIVE FASTING IN PEDIATRIC AGE GROUP

METHODS : Presenting a case report of delayed recovery in a 2 year old male child with unilateral hydrocele posted for herniotomy. After thorough preanaesthetic evaluation, the child belonging to ASA PS I was advised to be kept NPO as per the standard guidelines and premedicated with syrup triclorfos 75 mg/kg and injection atropine 0.3 mg orally, 45 minutes before surgery. The child was taken up for surgery at 9.30 am under general anaesthesia with controlled ventilation using Proseal and caudal block for perioperative analgesia with2µg/kg dexmedetomidine in12 ml of 0.25% bupivacaine.

Intraoperative course was uneventful; child was given Ringers Lactate solution using Holliday Segar formula. On completion of surgery, patient was drowsy but responding to painful stimulation, pulse rate of 90 beats/min and 100% saturation. PLMA was removed and patient shifted to PACU.

In PACU, 45 minutes after surgery, child continued to be drowsy but pulserate was 54beats/min. This was treated with inj. atropine 0.3 mg IV after which it increased to 105 beats/min. But the child continued to be drowsy and on checking, the blood glucose was detected to be 65mg/dl. This was then treated with 25% dextrose 5 ml.

Initially, dexmedetomidine used as adjuvant to caudal block was suspected to be the cause of delayed recovery; but, during critical incident analysis, it was found that the child was fasted for over 12 hours preoperatively. This probably resulted in hypoglycaemia and delayed recovery.

RESULTS : Initially, dexmedetomidine used as adjuvant to caudal block was suspected to be the cause of delayed recovery; but, during critical incident analysis, it was found that the child was fasted for over 12 hours preoperatively. This probably resulted in hypoglycaemia and delayed recovery.

CONCLUSIONS : AS CHILDREN ARE MORE VULNERABLE TO HYPOGLYCEMIA,PROPER NPO GUIDELINES SHOULD BE FOLLOWED