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Pediatric pulmonologists approach to the pre-operative management of the asthmatic child
Keren Armoni-Domany1, Guy Gut, Ruth Soferman
1Sackler Faculty of Medicine, Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel.
Insights
Pediatric pulmonologists show significant variability in managing pre-operative asthma in children due to a lack of guidelines. Consensus guidelines are needed for consistent respiratory treatment of asthmatic children undergoing surgery.
Area of Science:
- Pediatric Pulmonology
- Anesthesiology
- Respiratory Medicine
Background:
- Asthma management in pediatric surgical patients lacks standardized pre-operative guidelines.
- Current practices vary significantly among specialists.
- This variability impacts respiratory care for children undergoing elective procedures.
Purpose of the Study:
- To assess the attitudes and practices of pediatric pulmonologists concerning pre-operative asthma management.
- To identify areas of consensus and divergence in pre-operative respiratory care for asthmatic children.
- To highlight the need for evidence-based guidelines.
Main Methods:
- A nationwide survey was conducted among all 48 certified pediatric pulmonologists in Israel.
- A 20-question questionnaire, including six clinical scenarios, was used to gather data.
- A 100% response rate ensured comprehensive data collection on pre-operative management approaches.
Main Results:
- All surveyed pulmonologists agreed on the necessity of pre-operative treatment for asthmatic children.
- There was considerable variability in consulting pediatric pulmonologists (50% always vs. 50% selectively).
- Significant divergence was observed in the use of bronchodilators, inhaled corticosteroids, systemic steroids, and treatment duration, particularly for preschool and poorly controlled children.
Conclusions:
- A notable variability exists among Israeli pediatric pulmonologists in managing pre-operative asthma, especially in high-risk cases.
- This variability is likely due to the scarcity of evidence-based data and established clinical guidelines.
- There is a clear need for consensus guidelines to standardize pre-operative respiratory management for pediatric asthma patients.
Objective:
No consensus guidelines exist for the respiratory treatment of asthmatic children referred for elective surgery. The aim of this study was to evaluate the attitude of pediatric pulmonologists regarding the pre-operative management of these children.
Methods:
A survey of pre-operative management of asthmatic children was conducted. All 48 certified pediatric pulmonologists in Israel completed a questionnaire that comprised 20 questions regarding their approach to pre-operative management including six case scenarios with a variety of clinical situations and treatments of children with asthma.
Results:
Response rate was 100%. All believed that pre-operative treatment should be considered in all asthmatic children. Almost 50% suggested that a pediatric pulmonologist should be consulted in all pre-operative assessments. 50% recommended consultation only in individual cases. Overall, results showed a very wide variability between responders especially in pre-school and poorly controlled school children. The variability referred to the use of bronchodilators, inhaled corticosteroids and their combination during the pre-operative days, the addition of systemic CS and the length of pre-operative treatment. Almost all participants suggested either the initiation or augmentation of pre-operative treatment in high risk situations.
Conclusions:
This data demonstrate an important variability among pediatric pulmonologists in Israel regarding the practice of pre-operative treatment of infants and children with asthma especially for the less controlled and high risk children. This is most probably explained by the paucity of evidence-based data and the lack of established guidelines. Consensus guidelines for the pre-operative management of asthmatic children are needed.
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