Perioperative respiratory adverse events during ambulatory anesthesia in obese children
Vesna Marjanovic1,2, Ivana Budic3,4, Mladjan Golubovic3,4
1Faculty of Medicine, University of Nis, Blvd. dr Zorana Djindjica 81, 18000, Nis, Serbia. vesna.marjanovic@medfak.ni.ac.rs.
Insights
Pediatric obesity increases risks for breathing problems during anesthesia. This review offers strategies to minimize these perioperative respiratory adverse events (PRAEs) in children, improving recovery.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Critical Care
Background:
- Obesity affects 20-30% of children globally, posing significant clinical challenges.
- Obese pediatric patients undergoing ambulatory anesthesia face a higher risk of perioperative respiratory adverse events (PRAEs).
Purpose of the Study:
- To provide evidence-based recommendations for minimizing PRAEs in obese children during ambulatory anesthesia.
- To enhance the safety and improve postoperative recovery for pediatric patients with obesity.
Main Methods:
- Comprehensive preoperative assessment tailored to obese pediatric patients.
- Application of specific anesthetic techniques including preoxygenation and optimized drug dosing.
- Utilization of noninvasive airway management, protective ventilation, and regional anesthesia.
Main Results:
- Specific anesthetic approaches, such as preoxygenation and optimized drug dosing, are crucial.
- Noninvasive airway management, mechanical ventilation, and complete neuromuscular blockade reversal aid in preventing PRAEs.
- Postoperative monitoring of oxygenation and ventilation is essential for managing obese children.
Conclusions:
- Implementing these recommendations can significantly reduce the severity of PRAEs in obese children.
- Minimizing PRAEs can lead to fewer unplanned hospitalizations and better overall postoperative outcomes.
Abstract:
Obesity is one of the most common clinical conditions in the pediatric population with an increasing prevalence ranging from 20 to 30% worldwide. It is well known that during ambulatory anesthesia, obese children are more prone to develop perioperative respiratory adverse events (PRAEs) associated with obesity. To avoid or at least minimize these adverse effects, a thorough preoperative assessment should be undertaken as well as consideration of specific anesthetic approaches such as preoxygenation before induction of anesthesia and optimizing drug dosing. The use of short-acting opioid and nonopioid analgesics and the frequent implementation of regional anesthesia should also be included. Noninvasive airway management, protective mechanical ventilation, and complete reversion of neuromuscular blockade and awake extubation also proved to be beneficial in preventing PRAEs. During the postoperative period, continuous monitoring of oxygenation and ventilation is mandatory in obese children. In the current review, we sought to provide recommendations that might help to reduce the severity of perioperative respiratory adverse events in obese children, which could be of particular importance for reducing the rate of unplanned hospitalizations and ultimately improving the overall postoperative recovery.
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