Anesthetic management of 23 procedures in four pediatric patients on an active ketogenic diet

Abstract

Objective To discuss the anesthetic implementations and risks in children who are actively on a ketogenic diet (KD). Methods This study is a retrospective medical record review of 23 procedures performed under general anesthesia for 4 pe- diatric patients on KD during 2020–2022. Demographic data were recorded for the patients, type of anesthesia and procedure, medications used during anesthesia, perioper- ative complications, duration of anesthesia and KD, and hospital discharge times. Results Four children underwent 23 procedures: 3 dental care procedures under general anesthesia and 20 magnetic res- onance imaging sessions under general anesthesia with a natural airway. At the time of anesthesia, the children were between 2–8 years old and had been on the KD for 2–24 months. While the mean duration of anesthesia was 56 minutes for magnetic resonance imaging, it was 146 minutes for dental therapy. Sevoflurane was used as an anesthetic agent during anesthesia induction and mainte- nance. Blood pH and glucose levels were monitored in patients who received general anesthesia for dental ther- apy. Blood glucose remained stable in all patients who under- went dental therapy, whereas blood pH decreased to 7.16 in one patient and IV bicarbonate was administered. There was no increase in seizure frequency from the baseline during the magnetic resonance imaging and den- tal therapy performed under general anesthesia. All pa- tients were discharged home the same day, and only the dental care patient who had developed metabolic acidosis was hospitalized. Conclusion Non-surgical procedures requiring general anesthesia in children on KD are well tolerated, whereas blood pH and glucose analysis should be monitored in procedures longer than 2 hours

Keywords

• anesthesia; acidosis; ketogenic diet; perioperative com- plications; seizure