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Frequency and severity of desaturation events during general anesthesia in children with and without upper
Insights
Children with mild upper respiratory infections (URIs) undergoing anesthesia experienced more minor oxygen desaturation events. However, these issues were generally treatable, suggesting anesthesia can be safely administered.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
Background:
- Anesthesia in children with mild upper respiratory infections (URIs) poses potential risks.
- Previous studies have yielded conflicting results regarding the safety of proceeding with anesthesia in these patients.
Purpose of the Study:
- To investigate the association between anesthesia and adverse respiratory events in pediatric patients with mild URIs.
- To assess the incidence of desaturation and reactive airway problems during anesthesia in children with mild URIs.
Main Methods:
- Prospective study involving 402 pediatric patients at a university medical center.
- Continuous monitoring of oxygen saturation (SpO2), capnography, and ECG.
- Anesthesiologist observed for complications; decisions to anesthetize were at the team's discretion.
Main Results:
- Thirty patients had mild URIs; 372 did not.
- Minor desaturation events (SpO2 ≤95% for 60s) were increased in the URI group (p=0.02).
- Bronchospasm was more frequent in intubated patients with URIs (p=0.016).
Conclusions:
- Children with mild URIs have a higher frequency of minor desaturation episodes.
- Intubated pediatric patients with URIs showed an increased incidence of bronchospasm.
- Anesthesia appears safe for children with mild URIs, as complications are typically manageable and without long-term effects.
Study Objective:
To determine whether anesthesia in the presence of a mild upper respiratory infection (URI) was associated with episodes of desaturation or reactive airway problems.
Design:
A prospective study.
Setting:
Inpatient and outpatient units of a university medical center.
Patients:
Four hundred two pediatric patients.
Interventions:
Patients were monitored with continuous recordings of oxygen saturation (SpO2), capnography, and electrocardiogram. A separate anesthesiologist was present throughout each case to observe for complications and interview the anesthesia team. The decision to anesthetize patients with a URI was left to the discretion of the anesthesia team.
Measurements And Main Results:
Thirty patients with a URI and 372 patients without one were studied. One hundred ninety-six patients were managed with endotracheal intubation and 206 with face mask; 15 in each group had a URI. There was no increase in major desaturation events (SpO2 of 85% or less for 30 or more seconds) but minor desaturation events (SpO2 of 95% or less for 60 or more seconds) were increased (p = 0.02). There was no increased frequency of laryngospasm (1 in 30 vs. 22 in 372), but there was a higher frequency of bronchospasm in intubated patients (2 in 15 vs. 1 in 181; p = 0.016).
Conclusions:
Children with a mild URI have an increased frequency of minor desaturation episodes, and intubated patients with a URI have an increased frequency of bronchospasm. It appears that children with a mild URI may be safely anesthetized, since the problems encountered are generally easily treated and without long-term sequelae.