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Perioperative Course of COVID-19 in Pediatric Patients Undergoing Emergency Surgeries
Raksha Kundal1, Ranju Singh1, Vishal Kant1
1Department of Anesthesiology, Lady Hardinge Medical College, Kalawati Saran Children Hospital, New Delhi, India.
Insights
Pediatric surgical patients with COVID-19 infection generally have good outcomes. Postoperative ventilation and mortality risks are low unless comorbidities are present.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Anesthesiology
Background:
- Adults with COVID-19 undergoing surgery face higher risks.
- Limited data exists on the perioperative outcomes of children with COVID-19 undergoing emergency surgery.
Purpose of the Study:
- To evaluate postoperative ventilation needs, oxygen requirements, and mortality in pediatric patients with COVID-19 undergoing emergency surgery.
Main Methods:
- Retrospective analysis of 22 pediatric patients with COVID-19 who had emergency surgery (April 2020-May 2021).
- Data included COVID-19 status, American Society of Anesthesiology (ASA) grading, comorbidities, and perioperative events.
- Outcomes assessed: oxygen desaturation, need for postoperative oxygen, ventilation, and mortality.
Main Results:
- Most patients (63.6%) were asymptomatic; 86.4% had ASA grade IE.
- Only one patient required postoperative ventilation and died, and this patient had comorbidities.
- No increased need for oxygen or postoperative ventilation was observed in uncomplicated cases.
Conclusions:
- Pediatric surgical patients with COVID-19 generally do not face increased risks of ventilation or mortality.
- Comorbidities significantly increase the risk of adverse outcomes in these patients.
Objective:
Adults with COVID-19 infection undergoing surgery have an increased risk of complications and mortality. However, literature mentioning the perioperative course and outcome of children with COVID-19 infection undergoing emergency surgery is still lacking. Therefore, we planned this study to observe the need for postoperative ventilation, oxygen requirements, and postoperative mortality in pediatric patients with COVID-19 infection scheduled for emergency surgery.
Methods:
After ethical committee approval, all the COVID-19-infected pediatric patients who underwent an emergency surgery from April 2020 to May 2021 were included. Data collected included details of COVID-19 disease, American Society of Anesthesiology (ASA) grading, comorbidities, perioperative details such as tachycardia or bradycardia, any oxygen desaturation (SpO2<90), need for postoperative oxygen therapy, postoperative ventilation, and recovery/death.
Results:
A total of 22 COVID-19-infected pediatric patients underwent emergency surgery in the study period. Fourteen (63.6%) were asymptomatic at the time of admission. Nineteen patients (86.4%) belonged to ASA grade IE and three (13.6%) patients belonged to ASA grade III E. Three patients (13.6%) had comorbidities. Only one patient had hypotension and tachycardia intraoperatively. The same patient needed postoperative ventilation and succumbed.
Conclusion:
Our study shows that pediatric surgical patients with COVID-19 infection do not exhibit an increased need for oxygen or postoperative ventilation, postoperative pulmonary complications, or high mortality unless there is associated comorbidity.
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