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[Pulmonary atelectasis during anesthesia in a boy with upper respiratory tract infection]
J Valdivia Santandreu1, S Alavedra Peñalba
1Servicios de Anestesiología, Hospital General de Palma de Mallorca. valdiv@arrakis.es
Insights
A child with an upper respiratory infection experienced lung atelectasis during anesthesia for adenoidectomy. The surgery was postponed, and a two-phase approach is suggested for managing pediatric airway infections.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Otolaryngology
Background:
- Upper airway infections (UAI) in children pose significant anesthetic risks.
- Managing pediatric patients with UAIs requires careful consideration due to potential respiratory complications.
- Chronic otitis media and asthma increase susceptibility to respiratory issues.
Observation:
- A 6-year-old boy with UAI, asthma, and otitis media developed right upper lobe atelectasis immediately after tracheal intubation.
- Intraoperative findings included absent breath sounds on the right and hypoxemia.
- Fiberoptic bronchoscopy revealed mucous plugs, leading to postponement of adenoidectomy.
Findings:
- Pediatric upper airway infections significantly elevate the risk of intraoperative respiratory complications.
- Atelectasis and hypoxemia are critical risks in children with active UAIs undergoing airway procedures.
- Current consensus on managing such cases is lacking, necessitating revised protocols.
Implications:
- A staged anesthetic approach is proposed for children with UAIs undergoing adenoidectomy and myringotomy.
- Phase one involves myringotomy under mask anesthesia, followed by adenoidectomy after UAI resolution.
- This strategy aims to mitigate anesthetic risks associated with pediatric upper airway infections.
Abstract:
A 6-year-old boy was scheduled for adenoidectomy and bilateral myringotomy. The main features of his case history were chronic otitis media, bronchial asthma and signs and symptoms of upper respiratory tract infection (persistent runny nose and cough, occasionally with fever). Immediately after tracheal intubation we observed that the right side of the chest failed to rise with inspiration; breathing sounds were absent on the right and hypoxemia developed. A chest film taken in the operating room revealed upper right lobe atelectasis. Surgery was postponed and tracheobronchial lavage was performed with fiberoptic bronchoscopy and aspiration of mucous plugs. Upper airway infections are a common problem in children and increase the risk of respiratory complications during anesthesia. Patients with upper respiratory tract symptoms present a dilemma, and consensus about how to deal with such situations is lacking. We review the literature, discuss the anesthetic implications of upper airway infections, and suggest a two-phase approach for cases such as we report: first myringotomy using general anesthesia and a face mask, and second, once the upper airway infection has resolved, adenoidectomy with general anesthesia and tracheal intubation.