Fasting or starving? Measurement of blood ketone levels in 100 fasted elective and emergency adult surgical patients at an Australian tertiary hospital.

Prolonged fasting leads to a shift from carbohydrate to fat as the primary energy source, resulting in the production of ketones such as beta-hydroxybutyrate. Hyperketonaemia and ketoacidosis have been observed in young children fasting for surgery. The aim of this study was to investigate ketonaemia in adults fasted for surgery. One hundred non-diabetic adults presenting for elective or emergency surgery were assessed for the presence of hyperketonaemia (beta-hydroxybutyrate levels more than 1 mmol/l), and the relationship between beta-hydroxybutyrate, blood glucose and fasting duration was investigated. Three of 100 patients demonstrated hyperketonaemia, one of whom had ingested a ketogenic supplement the evening prior to surgery. No patient demonstrated beta-hydroxybutyrate levels suggestive of ketoacidosis (above 3 mmol/l). No relationship between fasting duration and ketone or glucose levels was observed. We found no evidence that prolonged preoperative fasting led to beta-hydroxybutyrate levels consistent with ketoacidosis.

Modification of Diamedica drawover anaesthetic equipment to facilitate introduction to an Australian teaching hospital.

We wanted to provide training in the use of drawover techniques and apparatus at an Australian teaching hospital. Equipment based on the Diamedica vaporiser was selected as it is suitable for use with sevoflurane. A lack of standards specific to drawover equipment from either anaesthetic professional bodies or national standards authorities hinders introduction of such equipment to Australian hospitals. Two systems were purchased, the Diamedica Portable Anaesthesia System and a Glostavent anaesthetic machine. Changes made to the equipment to increase its safety and to comply with Australian standards are described.