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Should you cancel the operation when a child has an upper respiratory tract infection?
1Department of Community Health Sciences and Anesthesia, University of Manitoba, Winnipeg, Canada.
Insights
Children with upper respiratory tract infections (URIs) face significantly higher risks for respiratory complications during and after surgery. Anesthesia and surgery in these young patients require increased perioperative monitoring and management.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Surgical Risk Assessment
Background:
- Cancelling pediatric surgeries due to upper respiratory tract infections (URIs) is often impractical.
- Limited data exists on the specific risks of anesthesia and surgery in children with URIs.
Purpose of the Study:
- To quantify the additional risk of adverse events in children with preoperative URIs undergoing anesthesia and surgery.
- To identify specific risk factors and complications associated with URIs in this population.
Main Methods:
- Analysis of a large prospectively collected pediatric anesthesia database.
- Comparison of outcomes between 1283 children with preoperative URIs and 20,876 children without URIs.
- Statistical analysis to control for confounding variables like age, physical status, and surgical type.
Main Results:
- Children with URIs were 2-7 times more likely to experience respiratory adverse events intraoperatively, in recovery, and postoperatively.
- These children also showed significant temperature regulation disruptions.
- Endotracheal anesthesia in children with URIs increased respiratory complication risk 11-fold.
- No increased risk for other adverse events was observed beyond respiratory and temperature issues.
Conclusions:
- Administering general anesthesia to children with URIs is not without significant risk.
- Children with URIs require enhanced observation and management throughout all perioperative phases.
- The findings underscore the need for careful consideration before proceeding with surgery in children with URIs.
Abstract:
Cancelling an operation when a child has an upper respiratory tract infection (URI) is not always feasible or practical. Yet we know very little about the additional risk posed by a URI occurring in a child undergoing anesthesia and surgery. Using a large prospectively collected pediatric anesthesia database, we studied 1283 children with a preoperative URI and 20,876 children without a URI. We found that children with a URI were two to seven times more likely to experience respiratory-related adverse events during the intraoperative, recovery room, and postoperative phases of their operative experience. Although these children also experienced significant disruptions in temperature regulation, they were not at risk for any other deleterious events. The elevation in risk after URI as compared with children without a URI was not explained by differences in age, physical status scores, surgical site, and emergency or elective status. However, if a child had a URI and had endotracheal anesthesia, the risk of a respiratory complication increased 11-fold (95% confidence intervals 6.8, 18.1). We conclude that the administration of general anesthesia to children with a URI is not benign and that these children require more observation/management in all perioperative phases of their surgical procedure.