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Published on: August 7, 2017
Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections
A R Tait1, S Malviya, T Voepel-Lewis
1Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor 48109, USA. atait@umich.edu
Insights
Children with upper respiratory infections (URIs) face increased risks for adverse respiratory events during anesthesia for elective surgery. However, most can proceed safely, with specific risk factors identified for potential complications.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Surgical Risk Assessment
Background:
- Anesthesizing children with upper respiratory infections (URIs) poses challenges.
- Identifying risks for adverse respiratory events in these children is crucial.
Purpose of the Study:
- To determine the incidence of adverse respiratory events in children with URIs undergoing elective surgery.
- To identify risk factors associated with these events.
Main Methods:
- Prospective study of 1,078 children (1 month-18 yr) undergoing elective surgery.
- Data collected via questionnaires and prospective monitoring of perioperative respiratory events.
- Postoperative follow-up to assess outcomes.
Main Results:
- Children with active or recent URIs had more breath-holding episodes, desaturation events, and overall adverse respiratory events.
- Risk factors included age, prematurity, reactive airway disease, paternal smoking, airway surgery, secretions, and nasal congestion.
- No long-term adverse sequelae were observed despite increased event incidence.
Conclusions:
- Several risk factors for perioperative adverse respiratory events in children with URIs were identified.
- Children with URIs are at higher risk but can often undergo elective procedures safely.
- Risk stratification aids in managing anesthesia for these patients.
Background:
Anesthesia for the child who presents for surgery with an upper respiratory infection (URI) presents a challenge for the anesthesiologist. The Current prospective study was designed to determine the incidence of and risk factors for adverse respiratory events in children with URTs undergoing elective surgical procedures.
Methods:
The study population included 1,078 children aged 1 month to 18 yr who presented for an elective surgical procedure. Parents were given a short questionnaire detailing their child's demographics, medical history, and presence of any symptoms of a URT. Data regarding the incidence and severity of perioperative respiratory events were collected prospectively. Adverse respiratory events (any episode of laryngospasm, bronchospasm, breath holding > 15 s, oxygen saturation < 90%, or severe cough) were recorded. In addition, parents were contacted 1 and 7 days after surgery to determine the child's postoperative course.
Results:
There were no differences between children with active URIs, recent URIs (within 4 weeks), and asymptomatic children with respect to the incidences of laryngospasm and bronchospasm. However, children with active and recent URIs had significantly more episodes of breath holding, major desaturation (oxygen saturation < 90%) events, and a greater incidence of overall adverse respiratory events than children with no URIs. Independent risk factors for adverse respiratory events in children with active URIs included use of an endotracheal tube (< 5 yr of age), history of prematurity, history of reactive airway disease, paternal smoking, surgery involving the airway, the presence of copious secretions, and nasal congestion. Although children with URIs had a greater incidence of adverse respiratory events, none were associated with any long-term adverse sequelae.
Conclusions:
The current study identified several risk factors for perioperative adverse respiratory events in children with lulls. Although children with acute and recent URIs are at greater risk for respiratory complications, these results suggest that most of these children can undergo elective procedures without significant increase in adverse anesthetic outcomes.
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