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Premedication with salbutamol prior to surgery does not decrease the risk of perioperative respiratory adverse events
A Ramgolam1,2, G L Hall2,3,4, D Sommerfield1
1Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Roberts Road, Perth, WA 6008, Australia.
Insights
Inhaled salbutamol did not significantly reduce perioperative respiratory adverse events (PRAE) in high-risk children undergoing surgery. This finding suggests salbutamol is not effective for preventing PRAE in this pediatric population.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Respiratory Medicine
Background:
- Perioperative respiratory adverse events (PRAE) are a significant cause of morbidity and mortality in children.
- Identifying effective preventative strategies for PRAE in high-risk pediatric patients is crucial.
Purpose of the Study:
- To investigate the efficacy of inhaled salbutamol premedication in reducing PRAE in children at high risk.
- To assess the impact of salbutamol on specific events like bronchospasm, laryngospasm, airway obstruction, desaturation, coughing, and stridor.
Main Methods:
- A double-blinded, randomized controlled trial was conducted involving children aged 6-16 years with at least two risk factors for PRAE.
- Participants were randomized to receive either 200 µg of inhaled salbutamol or a placebo before elective surgery.
- Perioperative respiratory adverse events were systematically recorded and analyzed.
Main Results:
- A total of 462 children were included in the intention-to-treat analysis.
- The incidence of PRAE was 14% in the placebo group and 12% in the salbutamol group, a difference that was not statistically significant (OR: 0.83, P=0.51).
- Specific events like oxygen desaturation and severe coughing did not significantly differ between the groups.
Conclusions:
- Premedication with inhaled salbutamol did not significantly reduce the risk of PRAE in children aged 6-16 years undergoing surgery.
- The study did not find evidence to support the use of salbutamol for preventing perioperative respiratory complications in this high-risk pediatric group.
Background:
Perioperative respiratory adverse events (PRAE) remain the leading cause of morbidity and mortality in the paediatric population. This double-blinded randomized control trial investigated whether inhaled salbutamol premedication decreased the occurrence of PRAE in children identified as being at high risk of PRAE.
Methods:
Children with at least two parentally reported risk factors for PRAE undergoing elective surgery were eligible for recruitment. They were randomized to receive either salbutamol (200 µg) or placebo prior to their surgery and PRAE (bronchospasm, laryngospasm, airway obstruction, desaturation, coughing and stridor) were recorded.
Results:
Out of 470 children (6-16 yr, 277 males, 59%) recruited, 462 were available for an intention-to-treat analysis. Thirty-two (14%) and 27 (12%) children from the placebo and salbutamol groups experienced PRAE. This difference was not significant [odds ratio (OR): 0.83, 95% confidence interval (CI): 0.48-1.44, P : 0.51]. Oxygen desaturation [14/232 (6%) vs 14/230 (6%), OR: 1.01, 95% CI: 0.47-2.17, P : 0.98] and severe coughing [12/232 (5%) vs 10/230 (4%), OR: 0.83, 95% CI: 0.35-1.97, P : 0.68] were the most common PRAE, but did not significantly differ between the groups. The occurrence of PRAE was slightly lower in children with respiratory symptoms who received salbutamol compared with placebo [16/134 (12%) vs 21/142 (15%), OR: 0.93, 95% CI: 0.38-2.26, P : 0.87], but was not significantly different.
Conclusions:
Premedication with salbutamol to children aged between 6 and 16 years and at high risk of PRAE prior to their surgery did not reduce their risk of PRAE.
Trial Registration Number:
ACTRN12612000626864 ( www.anzctr.org.au ).
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