Correlation between duration of preoperative fasting and
emergence delirium in pediatric patients undergoing
ophthalmic examination under anesthesia: A prospective
Department of Anaesthesiology, Pain
Medicine & Critical Care, All India Institute
of Medical Sciences, New Delhi, India
Dr Souvik Maitra, Department of
Anaesthesiology, Pain Medicine & Critical
Care, All India Institute of Medical Sciences,
New Delhi, India.
The study was funded by departmental/
institutional resources. Dr Puneet Khanna
received travel grant for presenting a version
of this study from Indian Council of Medical
Research [No. 3/2/TG-88/HRD-2018 (9)] at
the SPA/AAP Pediatric Anesthesiology 2018
meeting, Phoenix, AZ.
Section Editor: Francis Veyckemans
Background: Preoperative fasting in children can cause anxiety, which may ultimately
lead to postoperative emergence delirium. However, no data are available whether
duration of preoperative fasting correlates with postoperative emergence delirium.
Aims: The aim of this study was to identify if there is any correlation between the
duration of preoperative fasting and emergence delirium in children undergoing oph-
thalmic examination under anesthesia.
Methods: In this prospective observational study, 100 children between the age group
2-6 years of American Society of Anesthesiologists physical status I or II, scheduled for
examination of the eye under general anesthesia with sevoflurane were recruited. Data
regarding preoperative fasting was recorded and presence of emergence delirium was
assessed by the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 minute
interval till 30 minutes from the time of leaving the operation theater. No premedica-
tion was used in any patients but parental presence was allowed in all of them.
Results: Mean (standard deviation) duration of fasting to clear liquid was 6.3 (1.7)
hrs. Twenty-four children (24%) had at least 1 recorded PAED score >10 at any
time point in the postoperative period. PAED scores at 15 and 25 minutes were sig-
nificantly correlated with duration of fasting (r
[95% CI] = .24 [0.04, 0.41], P = .02,
Pearsons’s correlation and r
[95% CI] = .23 [0.04, 0.41], P = .02, Pearsons’s correla-
tion, respectively). No correlation has been found between duration of fasting and
blood glucose level (r
[95% CI] = À.05 [À0.24, 0.15], P = .65, Pearsons’s correla-
tion) between fasting blood glucose and PAED score at any time point.
Conclusion: Increased preoperative fasting duration may be a risk factor for postop-
erative emergence delirium in children undergoing ophthalmic examination under
emergence delirium, pediatric, preoperative fasting, sevoflurane
Abstract of this manuscript has been accepted for presentation at the SPA/AAP Pediatric Anesthesiology 2018 meeting to be held March 23-25, 2018 in Phoenix, AZ.
Accepted: 15 March 2018
Pediatric Anesthesia. 2018;28:547–551. wileyonlinelibrary.com/journal/pan © 2018 John Wiley & Sons Ltd