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Upper respiratory tract infections and general anaesthesia in children. Peri-operative complications and oxygen
L Levy1, U A Pandit, G I Randel
1Section of Pediatric Anesthesiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor 48109.
Insights
Children with acute or recent upper respiratory tract infections face increased risks of hypoxemia (low oxygen saturation) during transfer and recovery after general anesthesia for myringotomy surgery.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Surgical Complications
Background:
- Conflicting literature exists on the safety of anesthesia in children with upper respiratory tract infections (URTIs).
- Previous studies have not consistently identified increased risks associated with URTI in pediatric surgical patients.
Purpose of the Study:
- To investigate the association between URTI status and perioperative respiratory complications in children undergoing elective surgery.
- To quantify the incidence of hypoxemia in children with and without URTIs during anesthesia for myringotomy and grommet insertion.
Main Methods:
- A prospective study involving 130 children undergoing general anesthesia with face mask for myringotomy and grommet insertion.
- Children were categorized into three groups: acute URTI, recent URTI, and asymptomatic.
- Respiratory and related complication severity scores were recorded, and peripheral oxygen saturation was monitored throughout the perioperative period.
Main Results:
- No significant differences in overall complication scores were observed between the groups.
- However, the incidence of hypoxemia (oxygen saturation ≤ 93%) was significantly higher in children with acute URTI during transfer and recovery.
- Children with recent URTI also showed a significantly greater incidence of hypoxemia during transfer compared to asymptomatic children.
Conclusions:
- While overall complication scores may not differ, children with acute or recent URTIs are at a significantly increased risk of hypoxemia during specific perioperative phases.
- These findings highlight the importance of careful monitoring of oxygen saturation in pediatric patients with URTIs undergoing anesthesia.
- Further research may be warranted to explore specific anesthetic management strategies for this patient population.
Abstract:
Conflicting reports regarding the hazards of anaesthesia in children presenting for surgery with an upper respiratory tract infection have appeared in the literature. In the present study 130 children undergoing general anaesthesia with face mask for myringotomy and grommet insertion were graded as having either an acute or recent upper respiratory tract infection or were asymptomatic according to predetermined clinical symptoms and signs. The severity of respiratory and related complications were scored during induction, emergence and recovery. The peripheral oxygen saturation was recorded during induction, emergence, transfer to the recovery ward and in the recovery ward itself. There were no significant differences (p greater than 0.05) in the complication scores between the three groups of children. However, the incidence of hypoxaemia (oxygen saturation less than or equal to 93%) was significantly greater during transfer in the acute infection group (p = 0.001) and the recent infection group (p = 0.02), as well as during recovery in the acute group (p = 0.03) compared with asymptomatic children.