COVER STORY / ADVERTISING FEATURE
Perioperative metabolic monitoring in children
Benjamin J Blaise introduces a new study which is using POCT technology to address an underrecognised risk in paediatric anaesthesia.
PP October 2026
Volume 27 Issue 7
www.pathologyinpractice.com PIP cover
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The challenges of FIGS (Fasting Induced Hypoglycaemia during Surgery)
28/09/2026 14:23
Preoperative fasting is an essential component of safe anaesthetic practice, reducing the risk of pulmonary aspiration during general anaesthesia. However, while fasting protocols are well established, less atention has traditionally been paid to their metabolic consequences, particularly in children.1 Children have limited glycogen reserves and higher metabolic demands compared with adults, making them more vulnerable to fasting-induced hypoglycaemia and ketosis.2 Despite this physiological reality,
perioperative glucose monitoring is not routinely performed in many healthcare setings, and metabolic disturbances may go undetected during anaesthesia. Recognising this gap, investigators
across the United Kingdom launched the Fasting Induced Hypoglycaemia in Anaesthetised Paediatric Patients (FIGS) study, one of the largest prospective studies ever undertaken to evaluate the metabolic effects of preoperative fasting in children. The project aims to generate evidence that could influence future perioperative care pathways and inform the potential role of glucose and ketone monitoring in paediatric patients.3
Why metabolic monitoring matters Current paediatric perioperative guidelines acknowledge the risk of fasting- related metabolic complications.1 The Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) has recommended that children undergoing surgery may receive intravenous fluids without dextrose supplementation and that blood glucose monitoring should be considered when dextrose is not administered.6 While severe hypoglycaemia is
relatively uncommon, even mild-to- moderate reductions in blood glucose can have clinical significance. Prolonged fasting may also trigger ketone production, indicating a metabolic shift toward fat utilisation. Elevated ketone levels can occur before clinically apparent hypoglycaemia and may therefore serve as an early indicator of metabolic stress.4 In routine clinical practice, both
hypoglycaemia and ketosis can remain unrecognised during anaesthesia, when patients are unable to communicate symptoms.5 This creates a compelling rationale for
objective biochemical monitoring during the perioperative period.
The FIGS study aims to generate evidence that could influence future perioperative care pathways and inform the potential role of glucose and ketone monitoring in paediatric patients.
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WWW.PATHOLOGYINPRACTICE.COM October 2026
The FIGS study The UK FIGS study is a multicentre observational project involving approximately 2,900 children across 25 UK centres. The study examines blood glucose
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