Opieka anestezjologiczna u dzieci z epilepsją leczonej dietą ketogenną - przegląd edukacyjny

PURPOSE: Ketogenic diet therapy (KDT) is a nonpharmacologic treatment for pediatric drug-resistant epilepsy that induces ketosis through high-fat, low-carbohydrate intake. These children frequently present for anesthesia, and their baseline metabolic alterations, compounded by fasting and surgical stress, place them at higher risk of perioperative complications than other pediatric patients. This educational review organizes anesthetic considerations into preoperative, intraoperative, and postoperative phases and synthesizes them into best-practice recommendations for perianesthesia clinicians. DESIGN: Educational review. METHODS: A research librarian-assisted search of PubMed and Ovid MEDLINE was conducted in June 2025, limited to English-language publications from 2015 forward; of 202 unique records screened, 83 underwent full-text review, and 14 met inclusion criteria, and an unrestricted hand-search of included studies' reference lists added seven more, for 21 included studies (seven case reports, one case series, five retrospective record reviews, two prospective cohorts, two animal studies, three narrative reviews, and one summary of expert opinion). FINDINGS: Across this literature, the central requirement is maintenance of ketosis throughout all phases of perioperative care, with evaluation of every medication and intravenous fluid for carbohydrate and gluconeogenic potential, metabolic monitoring with prompt recognition and treatment of acidosis and hypoglycemia, anesthetic technique tailored to the patient's comorbidities and the planned procedure, and interdisciplinary coordination with the ketogenic diet team. CONCLUSIONS: The evidence base remains dominated by case reports and retrospective record reviews, with no randomized trials in this population, limiting generalizability; nonetheless, reviews and guidelines published since 2020 provide a workable foundation for safe perioperative care.