Harmful Metabolic Acidosis in Children Treated by Ketogenic Diet During Prolonged General Anesthesia for Epilepsy Surgery: A Single Center Experience
Abstract number :
2.569
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
1525
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Rayann Checri, MD – Rothschild Foundation Hospital, Paris, France
Severine Gras, MD – Rothschild Foundation Hospital, Paris, France
Simon Clariot, MD – Rothschild Foundation Hospital, Paris, France
Anais Chivet, MD – Rothschild Foundation Hospital, Paris, France
Marie-Thérèse Dangles, MD – Rothschild Foundation Hospital, Paris, France
Julie Bonheur, MD – Rothschild Foundation Hospital, Paris, France
Nathalie Dorison, MD – Rothschild Foundation Hospital, Paris, France
Presenting Author: Mathilde Chipaux-Raffo, MD, PhD – Rothschild Foundation Hospital, Paris, France
Pierre Trouiller, MD – Rothschild Foundation Hospital, Paris, France
Christine Bulteau, MD,PhD – Rothschild Foundation Hospital, Paris, France
Sarah Ferrand-Sorbets, MD – Rothschild Foundation Hospital, Paris, France
Jean-Michel Devys, MD – Rothschild Foundation Hospital, Paris, France
Emmanuel Raffo, MD, PhD – Rothschild Foundation Hospital, Paris, France
Rationale: Management of ketogenic diet (KD) in case of prolonged anesthesia in children.
Methods: We conducted a retrospective study in the pediatric neurosurgery department of Rothschild Hospital Foundation Rothschild in France. All the children who underwent long term anesthesia ( >4h) in case of neurosurgery for drug resistant pediatric epilepsy surgery between September 2020 and January 2024 were included.
Results: 22 patients were included. After 4 hour of anesthesia, children maintained in strict ketogenic diet (KD-S, n=3), exhibit non-lactic metabolic acidosis (pH 7.13 vs 7.34, p=1.38x10-9) associated with an increased anion gap (17.1mM vs 9.6mM, p=1.58 x10-4). In addition to the association between severe acidosis and KD, an association was found between moderate acidosis (pH < 7.3) and KD (OR 4.67, p = 0.04) or Topiramate (OR 9.33, p=0.01).
Conclusions: Current recommendations for anesthesia during long term anesthesia ( >4h) with strictly no-carbohydrates intakes during anesthesia in case ok KD may be at risk of life-threatening metabolic acidosis, in a context of absence of protocolized monitoring of variations in hyperketosis throughout a prolonged fast. A KD-management protocol, including routine monitoring of ketosis in addition to usual monitoring (lactacidemia, kaliemia and glycemia), and low carbohydrates intravenous perfusion throughout prolonged general anesthesia, should be implemented throughout prolonged general anesthesia, especially for younger infants (< 2 years).
Funding: No
Surgery