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Published on: December 10, 2013
Association between preoperative respiratory symptoms and perioperative respiratory adverse events in pediatric
Rita Saynhalath1, Proshad N Efune1, Paul A Nakonezny2
1Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
Insights
Children with viral respiratory infections undergoing anesthesia did not show increased risk of perioperative respiratory adverse events (PRAE) regardless of symptoms. Fever within 48 hours, however, was associated with higher PRAE risk.
Area of Science:
- Pediatric Anesthesiology
- Infectious Diseases
- Respiratory Medicine
Background:
- Perioperative respiratory adverse events (PRAE) are a concern in pediatric patients with viral infections.
- Understanding the specific risks associated with different viral pathogens, including SARS-CoV-2, is crucial for optimizing patient safety.
Purpose of the Study:
- To investigate the association between upper respiratory tract viral infection symptoms and PRAE in children.
- To compare the risk of PRAE in children infected with SARS-CoV-2 versus other respiratory viruses.
Main Methods:
- Prospective cohort study involving 196 children under 18 undergoing general anesthesia with positive viral testing.
- PRAE incidence and severe adverse events were measured within 7 days postoperatively.
- Outcomes included oxygen desaturation, need for supplemental oxygen, laryngospasm, bronchospasm, and other severe events.
Main Results:
- No significant difference in PRAE risk was found between symptomatic and asymptomatic children with viral infections.
- The risk of PRAE was notably higher in children with fever within 48 hours of anesthesia.
- No significant difference in PRAE risk was observed between SARS-CoV-2 (Omicron variant) and other respiratory viruses.
Conclusions:
- Symptom presence alone does not significantly alter PRAE risk in children with confirmed viral respiratory infections.
- Recent fever is a key indicator of increased PRAE risk in this pediatric population.
- Current evidence suggests similar PRAE risks between SARS-CoV-2 and other common respiratory viruses in children.
Study Objective:
To determine the association between the presence of upper respiratory tract viral infection symptoms and occurrence of perioperative respiratory adverse events (PRAE) in children with positive viral screening, and to analyze the risk of PRAE in children with SARS-CoV-2 compared to non-SARS-CoV-2 infection.
Design:
A prospective cohort study.
Setting:
A tertiary, freestanding pediatric hospital in Dallas, Texas.
Patients:
Children <18 years of age with positive respiratory viral testing who underwent general anesthesia.
Intervention:
Measurement of incidence of PRAE and severe adverse events during the first 7 postoperative days.
Measurements:
The primary outcome was a composite of PRAE: oxygen saturation < 90% for >5 min, supplemental oxygen for >2 h after anesthesia, laryngospasm, and bronchospasm. The secondary outcome was severe adverse events: high flow nasal cannula >6 l of oxygen per minute, admission to the ICU for escalation of respiratory support post-anesthetic, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death.
Main Results:
In this convenience sample of 196 children, 83 were symptomatic and 113 were asymptomatic. The risk of PRAE was similar in children with active viral symptoms and asymptomatic children (risk difference: -1.9%; 95% CI: -10.9, 7.9%), but higher among children with documented fever within 48 h of the anesthetic (risk difference: 20.8%; 95% CI: 5.3, 39.7%). The multivariable adjusted odds ratio of PRAE was 0.68 (95% CI: 0.25, 1.85) for symptomatic compared to asymptomatic patients, and 0.46 (95% CI: 0.14, 1.44) for patients with SARS-CoV-2 compared to non-SARS-CoV-2 infection.
Conclusions:
There was no significant difference in the incidence of PRAE between symptomatic and asymptomatic children with laboratory confirmed viral respiratory infection, and between children with the Omicron variant of SARS-CoV-2 compared to non-SARS-CoV-2 respiratory viruses. However, the risk was increased in children with recent fever.
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