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Ad-hoc preoperative management and respiratory events in pediatric anesthesia during the first COVID-19 lockdown-an
Markus Zadrazil1, Peter Marhofer1,2, Werner Schmid3
1Department of Anesthesia, General Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria.
Insights
Early pre-anesthetic management did not significantly impact pediatric anesthesia safety during COVID-19. Respiratory events remained rare, suggesting current practices are effective for low-risk children.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Pre-anesthetic management in children focuses on airway risk factors.
- The COVID-19 lockdown provided a unique opportunity to assess an ad-hoc management strategy's impact on intraoperative respiratory events.
Purpose of the Study:
- To evaluate the effect of an ad-hoc pre-anesthetic management strategy during the COVID-19 lockdown on intraoperative respiratory events in pediatric patients.
- To compare respiratory event rates between the lockdown period and previous years.
Main Methods:
- Observational cohort study of pediatric patients (0-18 years, ASA I-II) undergoing elective surgery.
- Comparison between cases during the first COVID-19 lockdown (March-May 2020) and the same period in 2017-2019.
- Primary outcome: drop in peripheral oxygen saturation (SpO2) below 90%.
Main Results:
- No significant difference in the primary outcome or event counts between the lockdown and previous periods (p>0.05).
- Respiratory events were rare, even under general anesthesia.
- Younger age, endotracheal intubation, and bronchopulmonary procedures were associated with increased SpO2 events.
Conclusions:
- Early pre-anesthetic assessment may not enhance pediatric anesthesia safety.
- A high rate of anesthesia without airway manipulation at the study center may contribute to low respiratory event rates.
Background:
Early pre-anesthetic management for surgery is aimed at identifying risk factors, which notably in children are mostly airway related. The first COVID-19 lockdown opened a unique 'window of opportunity' to study what impact an ad-hoc management strategy would bring to bear on intraoperative respiratory events.
Methods:
In this observational cohort study we included all patients with an American Society of Anesthesiology (ASA) Physical Status of I or II, aged 0 to ≤18 years, who underwent elective surgery at our center during the first national COVID-19 lockdown (March 15th to May 31st, 2020) and all analogue cases during the same calendar period of 2017-2019. The primary outcome parameter was a drop in peripheral oxygen saturation (SpO2) below 90% during anesthesia management. The study is completed and registered with the German Clinical Trials Register, DRKS00024128.
Results:
Given 125 of 796 evaluable cases during the early 2020 lockdown, significant differences over the years did not emerge for the primary outcome or event counts (p>0.05). Events were exceedingly rare even under general anesthesia (n = 3) and non-existent under regional anesthesia (apart from block failures: n = 4). Regression analysis for SpO2 events <90% yielded no significant difference for ad-hoc vs standard preoperative management (p = 0.367) but more events based on younger patients (p = 0.007), endotracheal intubation (p = 0.007), and bronchopulmonary procedures (p = 0.001).
Conclusions:
Early assessment may not add to the safety of pediatric anesthesia. As a potential caveat for other centers, the high rate of anesthesia without airway manipulation at our center may contribute to our low rate of respiratory events.
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