The ketogenic diet (KD) has been a nonpharmacologic treatment option for patients with intractable epilepsy since the 1920s. The diet consists of high fat with low protein–carbohydrate content, which induces an increase in the ketone bodies and produces a ketotic state (1,2). Most children started on the diet have medically intractable seizures, and many also have medical issues that may require procedures with general anesthesia (GA). Hinton et al. (3) described three children on the KD that underwent inhalation anesthesia for minor surgery without complications. The anesthesia time was <35 min in all the patients; the preoperative fasting period was 10 h. McNeely (4) reported one adolescent on the KD who had a procedure requiring anesthesia for 5 h and 20 min. However, the literature on the safety of undergoing GA while on the KD is scarce, and there is no consensus on how to proceed when children are on the diet and require GA procedures. Some centers taper or discontinue the KD 1 week or even the day before the surgery, whereas others continue the diet without a specific protocol (personal communications).
This retrospective study was undertaken to define the safety and the possible risks associated with surgical procedures and GA in children on the KD.