Preoperative Fasting and Perioperative Outcomes in Children Undergoing Elective Circumcision

This single-center, prospective observational study will be conducted at Yahyali State Hospital, Kayseri, Türkiye, and will include children aged 1-10 years scheduled for elective circumcision under general anesthesia. Children with American Society of Anesthesiologists (ASA) physical status I-II will be eligible for inclusion. Written informed consent will be obtained from parents or legal guardians before enrollment.

During the preoperative anesthesia assessment, families will receive verbal instructions regarding fasting requirements in accordance with routine institutional practice. On the day of surgery, parents will be asked to report the time of their child's last solid food and clear liquid intake. Actual fasting durations will be calculated in hours and recorded separately.

Demographic and clinical characteristics, including age, height, weight, body mass index, ASA physical status, comorbidities, and previous anesthesia or surgical experience, will be documented. Maternal and paternal educational levels will also be recorded.

Before surgery and prior to the administration of any sedative medication, children's anxiety levels will be assessed using the Modified Yale Preoperative Anxiety Scale (m-YPAS). Parental situational anxiety will be evaluated using the State-Trait Anxiety Inventory-State (STAI-State).

Preoperative blood glucose levels will be measured immediately after routine peripheral intravenous cannulation and before the administration of intravenous fluids or medications. No additional venipuncture will be performed for research purposes.

Actual solid food and clear liquid fasting durations will be analyzed as continuous variables to investigate their associations with children's preoperative anxiety scores, parental anxiety scores, and blood glucose levels. Participants will also be classified according to whether their fasting durations are consistent with current pediatric fasting recommendations or exceed the recommended durations.

The relationship between parental educational levels and adherence to fasting recommendations will be evaluated. Associations between children's and parents' anxiety scores will also be examined.

Statistical analyses will include appropriate correlation analyses, group comparisons, and multivariable linear regression to assess the association between fasting duration and children's anxiety while considering potential confounding factors, such as age, previous anesthesia or surgical experience, parental anxiety, and parental educational levels. Statistical significance will be set at p < 0.05.

All surgical procedures, anesthesia management, and postoperative care will follow routine clinical practice. No experimental medications, additional invasive procedures, or modifications to standard treatment will be introduced as part of the study.