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Pulmonary and Ear-Nose-Throat Considerations in the Perioperative Period for Children with Medical Complexity
Laurie Murray1, Minyoung Jang2, Aliva De1
1Division of Pediatric Pulmonary, Columbia University Irving Medical Center, 3959 Broadway, CHC-701, New York, NY 10032, USA.
Insights
Preparing children with medical complexity (CMC) for surgery requires careful planning. Multidisciplinary assessments and optimizing respiratory and airway function are crucial to minimize surgical risks and complications.
Area of Science:
- Pediatric Surgery
- Respiratory Medicine
- Anesthesiology
Background:
- Children with medical complexity (CMC) are a growing population with extensive healthcare needs.
- CMC frequently require surgical interventions, necessitating meticulous perioperative planning.
- These children often present with complex respiratory issues, including ventilation support and pre-existing conditions like asthma and airway reactivity.
Purpose of the Study:
- To highlight the importance of comprehensive preoperative assessment for CMC undergoing surgery.
- To emphasize the multidisciplinary approach required for managing CMC.
- To outline key factors in optimizing pulmonary and airway status before surgical procedures in CMC.
Main Methods:
- Review of existing literature on the surgical management of CMC.
- Analysis of common comorbidities and respiratory challenges in CMC.
- Emphasis on the collaborative roles of Pulmonology, Otolaryngology, and Anesthesiology.
Main Results:
- CMC present unique challenges due to varied respiratory needs and comorbidities.
- Preoperative optimization of pulmonary and airway status is critical.
- Multidisciplinary team involvement is essential for successful surgical outcomes.
Conclusions:
- Thorough preoperative evaluation by specialists is vital for CMC.
- Optimizing respiratory and airway function reduces postoperative complications in CMC.
- A coordinated, multidisciplinary strategy ensures safer surgical care for children with medical complexity.
Abstract:
Children with medical complexity (CMC) represent a unique and growing population with multidisciplinary needs that require comprehensive management. CMC often require surgical procedures that need careful planning. They have variable baseline respiratory needs, including noninvasive ventilation, invasive mechanical ventilation, or tracheostomies. Additionally, they may have multiple coexistent conditions such as asthma or airway reactivity, oropharyngeal dysphagia, excessive oral secretions, aspiration, sleep-disordered breathing, and difficult airway scenarios. A thorough assessment by the Pulmonologist, Otolaryngologist, and Anesthesiologist of the underlying risk factors, along with pulmonary and airway optimization, is essential in preparing for surgical procedures to reduce the risk of postoperative complications.
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