J Korean Acad Nurs.  2011 Apr;41(2):157-164. 10.4040/jkan.2011.41.2.157.

Influence of Pre-operative Fasting Time on Blood Glucose in Older Patients

• Hong M
• Yoon H

• KMID: 1754156
• DOI: http://doi.org/10.4040/jkan.2011.41.2.157

Abstract

PURPOSE
This study was performed to identify changes in blood glucose at preoperative fasting time in surgical patients over 60 yr.
METHODS
Data collection was performed from July, 2008 through July, 2009. Participants consisted of 80 nondiabetic surgical patients. Blood glucose was checked from 3 to 5 times. The 5 times were 2-hr fasting on the pre-operative day (T1, n=80), 8 hr (T2, n=80), 10 hr (T3, n=17), 12 hr (T4, n=34) and 14 hr fasting on the day of the operation (T5, n=29).
RESULTS
Of the patients, 27.5% had a blood glucose level of less than 79 mg/dL at T2; 17.6% at T3; 32.4% at T4; and 17.2% at T5. Mean blood glucose levels were 93.8 mg/dL at T1; 88.4 mg/dL at T2; 91.7 mg/dL at T3; 87.4 mg/dL at T4: and 94.1 mg/dL at T5. Blood glucose was the lowest at T2 (p<.001).
CONCLUSION
As 17.6-32.4% of the patients showed the blood glucose level of less than 79 mg/dL at 8-14 hr pre-operative fasting, the authors recommend that surgical patients >60 yr-of-age be observed for hypoglycemia during pre-operative fasting of more than 10 hr and that surgical patients >60 yr-of-age with risks for hypoglycemia be scheduled for operation within 10 hr preoperative fasting.

Keyword

Fasting; Blood glucose

MeSH Terms

Aged
Aged, 80 and over
Blood Glucose/*analysis
Body Mass Index
*Fasting
Female
Hemoglobins/analysis
Humans
Hypoglycemia/blood/prevention & control
Male
Middle Aged
Preoperative Care
Risk
Serum Albumin/analysis
Sex Factors
Time Factors

Figure

• 

  Figure 1 Research design. OP=operative; X=Blood sampling for blood glucose.

Reference

1. Bagshaw SM, Bellomo R, Jacka MJ, Egi M, Hart GK, George C. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Critical Care. 2009. 13:R91.

2. Bremer JP, Jauch-Chara K, Hallschmid M, Schmid S, Schultes B. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care. 2009. 32:1513–1517.

3. Brierley EJ, Broughton DL, James OF, Alberti KG. Reduced awareness of hypoglycaemia in the elderly despite an intact counter-regulatory response. QJM : Monthly Journal of the Association of Physicians. 1995. 88:439–445.

4. Chang TH, Cho YH, Hong JG, Park JW. Effect of preoperative fasting on blood sugar and blood gas analysis. Korean Journal of Anesthesiology. 1982. 15:36–41.

5. Ganong WF. Review of medical physiology. 2005. 22 ed. Tokyo: McGraw-Hill.

6. Guettier JM, Gorden P. Hypoglycemia. Endocrinology and Metabolism Clinics of North America. 2006. 35:753–766. viii–viix.

7. Huh IY, Baek CH, Lee JD, Shin JW, Gwak MJ. Effects of fluid therapy on serum glucose level in pediatric outpatients. Korean Journal of Anesthesiology. 2006. 50:158–161.

8. Jeong G, Yoon H. The effect of anesthetic information on pre-operative anxiety, glucose, cortisol and epinephrine of patients undergoing tonsillectomy. Journal of Korean Biological Nursing Science. 2007. 9:143–151.

9. Jin J, Wang GL, Shi X, Darlington GJ, Timchenko NA. The age-associated decline of glycogen synthase kinase 3 beta plays a critical role in the inhibition of liver regeneration. Molecular and Cellular Biology. 2009. 29:3867–3880.

10. Kagansky N, Levy S, Rimon E, Cojocaru L, Fridman A, Ozer Z, et al. Hypoglycemia as a predictor of mortality in hospitalized elderly patients. Archives of Internal Medicine. 2003. 163:1825–1829.

11. Statistics on the aged. Korea National Statistical Office. 2010. Retrieved September 30, 2010. from http://kostat.go.kr/portal/korea/index.action.

12. Kweon YS, Han YJ, Kim DC, Song HS. Effect of preoperative fasting time on blood glucose concentrations in children. Korean Journal of Anesthesiology. 2000. 39:528–533.

13. Lee NH, Lee WK, Choi SH, Lee KY. Influence of replacement with ringer's lactate for preoperative NPO deficits on blood glucose concentration in children undergoing strabismus surgery. Anesthesia and Pain Medicine. 2009. 4:355–359.

14. Mannucci E, Monami M, Mannucci M, Chiasserini V, Nicoletti P, Gabbani L, et al. Incidence and prognostic significance of hypoglycemia in hospitalized non-diabetic elderly patients. Aging Clinical and Experimental Research. 2006. 18:446–451.

15. Matyka K, Evans M, Lomas J, Cranston I, Macdonald I, Amiel SA. Altered hierarchy of protective responses against severe hypoglycemia in normal aging in healthy men. Diabetes Care. 1997. 20:135–141.

16. Meneilly GS, Cheung E, Tuokko H. Altered responses to hypoglycemia of healthy elderly people. The Journal of Clinical Endocrinology and Metabolism. 1994. 78:1341–1348.

17. Morgan G, Mikhail M, Murray M. Clinical Anesthesiology. 2005. 4th ed. New York: McGraw-Hill.

18. Mori S, Ito H. Hypoglycemia in the elderly. Japanese Journal of Medicine. 1988. 27:160–166.

19. Statistics on major surgery. National Health Insurance Corporation. 2008. Retrieved September 30, 2010. from http://www.nhic.or.kr/portal/site/main/menuitem.

20. Ng CL. Hypoglycaemia in nondiabetic patients-an evidence. Australian Family Physician. 2010. 39:399–404.

21. Oh SH, Kim IH, Choi SR, Chung CJ. Causes of patient dissatisfaction with anesthetic care. Korean Journal of Anesthesiology. 2005. 48:387–392.

22. Ortiz-Alonso FJ, Galecki A, Herman WH, Smith MJ, Jacquez JA, Halter JB. Hypoglycemia counter regulation in elderly humans: Relationship to glucose levels. The American Journal of Physiology. 1994. 267:E497–E506.

23. Shilo S, Berezovsky S, Friedlander Y, Sonnenblick M. Hypoglycemia in hospitalized nondiabetic older patients. Journal of the American Geriatrics Society. 1998. 46:978–982.

24. Suh IS, Song SO, Park DP. Effects of starvation and perioperative fluid therapy on the blood glucose concentrations during anesthesia in children. Yeungnam University Journal of Medicine. 1984. 1:89–93.

25. Definition of an older or elderly person. World Health Organization. 2010. Retrieved October 30, 2010. from http://www.who.int/healthinfo/survey/ageingdefnolder/en/index.html.