Severe hypoglycaemia associated with preoperative fasting and intraoperative propranolol. A case report and discussion

administered at 06.45 h. Anaesthesia was induced at There has long been an interest in the blood glucose 08.45 h with thiopentone 75 mg intravenously and levels which may occur in paediatric patients during maintained with nitrous oxide (62%) in oxygen and the perioperative fasting period (1). The danger of isoflurane, initially 2% subsequently reduced to 1.5%. hypoglycaemia as a result of preoperative fasting has Pethidine 2.5 mg intravenously was repeated four been recognized and there are case reports of children times to a total dose of 10 mg over 15 min. A persistent who became symptomatic due to hypoglycaemia tachycardia of 146 bpm was reduced to 120 bpm before their operation (2). More recently liberalization following administration of propranalol 0.75 mg of preoperative fluid intake should prevent such in divided doses of 0.25 mg intravenously. The occurrences, but there is evidence that many children operation was completed in about 20 min. The patient still are subjected to prolonged periods of fasting was transferred to the recovery room and at 09.20 (3). The danger that propranolol may predispose was awake and restless and was given morphine to hypoglycaemia in both diabetic and nondiabetic 2.5 mg intramuscularly. The temperature was 36.5°C patients has been described (4), but may not be and the heart rate 100 bpm. The patient was returned well known to anaesthetists. The following case was to the ward by 1000 h, at which time he was conscious communicated to the authors who believe that the and trying to curl up and sleep. varied circumstances contributing to the tragic The child ‘slept’ for the next nine hours. As he consequences of prolonged hypoglycaemia should appeared comfortable no attempt was made to be widely reported. arouse him and hence the level of consciousness was