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Risk factors for adverse events in children with colds emerging from anesthesia: a logistic regression
J Rachel Homer1, Tom Elwood, Do Peterson
1Department of Anaesthesia, Aintree University Hospital, Liverpool, UK. rachelhomer@doctors.org.uk
Insights
Children with recent upper respiratory infections (URIs) face increased anesthesia risks. Specific preoperative symptoms, except low-grade fever, did not predict adverse events during emergence from anesthesia.
Area of Science:
- Pediatric Anesthesia
- Respiratory Medicine
- Surgical Risk Assessment
Background:
- Recent upper respiratory infections (URIs) in children elevate risks for respiratory adverse events post-anesthesia for elective surgery.
- This heightened risk persists for weeks after acute URI symptom resolution.
- Limited systematic analyses have identified specific risk factors associated with preoperative URIs.
Purpose of the Study:
- To investigate the relationship between preoperative URI symptoms and adverse events during emergence from anesthesia in pediatric patients.
- To identify specific preoperative symptoms that may predict respiratory adverse events.
Main Methods:
- Logistic regression analysis of combined data from control groups of prospective studies in pediatric anesthesia.
- Prospective recording of respiratory events (stridor, desaturations, coughing, laryngospasm) by blinded observers.
- Parental reporting of 10 cold symptoms within 6 weeks prior to surgery.
Main Results:
- No association was found between specific preoperative URI symptoms and respiratory adverse events during emergence, with low-grade fever showing a mild protective effect.
- Airway management techniques (device, extubation timing) significantly impacted adverse events.
- Increased adverse events were observed when peak URI symptoms occurred within 4 weeks prior to surgery.
Conclusions:
- Preoperative URI symptoms, individually, are not reliable predictors of respiratory adverse events during anesthesia emergence in children.
- Airway management and timing of recent URI symptoms are more critical factors influencing perioperative respiratory safety.
Background:
Recent upper respiratory infection (URI) in children increases respiratory adverse events following anesthesia for elective surgery. The increased risk continues weeks after resolution of acute URI symptoms. Few systematic analyses have explored specific risk factors. This logistic regression explores the relationship between preoperative URI symptoms and adverse events during emergence from anesthesia.
Methods:
Data were combined from control groups of several prospective observational and interventional studies in elective pediatric anesthesia in a tertiary care pediatric hospital. In each study, a blinded observer, distinct from the anesthesia care team, prospectively recorded the presence of stridor, oxygen desaturations (and their duration), coughing and laryngospasm. Parents were subsequently asked about the presence of 10 cold symptoms during the 6 weeks prior to operation.
Results:
Our model, based on a dataset of 335 patients, did not demonstrate an association between any particular symptoms and the rate of respiratory adverse events during emergence from anesthesia, with the exception of low-grade fever which appeared to be mildly protective. Respiratory adverse events were affected by the airway management technique (device used and timing of extubation), and adverse events were increased if peak URI symptoms had occurred within the preceding 4 weeks.
Conclusions:
Specific preoperative symptoms were not useful in predicting respiratory adverse events during emergence from anesthesia.
