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Anaesthesia in children with viral respiratory tract infections
1Department of Paediatric Anaesthesia, Women's and Children's Hospital, North Adelaide, South Australia.
Insights
Children with respiratory tract infections (RTIs) face increased risks during anesthesia. Postponing elective surgery for six weeks is recommended, while emergency procedures require modified anesthetic techniques to mitigate complications.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Infectious Diseases
Background:
- Respiratory tract infections (RTIs) are common in pediatric surgical patients.
- The risks of anesthesia in children with RTIs are debated, with significant socioeconomic implications for delaying procedures.
- Systemic effects of viral infections, including potential viral myocarditis, are not fully understood in this context.
Purpose of the Study:
- To review the effects and consequences of anesthesia in children with RTIs.
- To outline the increased incidence of intra- and postoperative respiratory complications following an RTI.
- To provide recommendations for anesthetic management in children with RTIs undergoing surgery.
Main Methods:
- Literature review of the effects of anesthesia in children with RTIs.
- Analysis of clinical effects and systemic impacts of common viral respiratory infections.
- Evaluation of intra- and postoperative respiratory complications up to six weeks post-RTI.
Main Results:
- Children with moderate to severe RTIs have an increased incidence of respiratory complications for up to six weeks after infection.
- Complications include airway obstruction, laryngeal spasm, bronchoconstriction, increased secretions, desaturation, and atelectasis.
- Viral myocarditis is a potential, though less recognized, systemic risk.
Conclusions:
- Elective surgery for children with moderate to severe RTIs should be postponed for six weeks.
- Emergency surgery necessitates modified anesthetic approaches, such as mask anesthesia or rapid sequence induction without cricoid pressure.
- Key strategies include controlled ventilation, awake extubation, vigilant postoperative respiratory monitoring, and adequate analgesia.
Abstract:
The effects and consequences of anaesthesia in a child with a respiratory tract infection (RTI) are controversial. There is a high incidence of viral RTI in children presenting for surgery and anaesthesia. The social and economic impact of postponing the procedure is significant; for the child, family and institution. The clinical effects of the common cold are well known, affecting the respiratory tract from the nose down to the small airways and lung parenchyma. The systemic effects of the toxic viraemic phase are also well recognized but not so the potential risk of a viral myocarditis. There is an increased incidence of intra- and postoperative respiratory related complications up to six weeks after a RTI. These include airway obstruction, laryngeal spasm, vagally mediated reflex bronchoconstriction, increased bronchial secretions, desaturation, atelectasis and postoperative respiratory complications. Children with symptoms of a moderate to severe RTI presenting for elective surgery should be postponed for six weeks. Emergency surgery should proceed with a mask anaesthetic for minor surgery or by adopting a modified rapid sequence induction (atropine but no cricoid pressure) to gain rapid control of the airway to avoid laryngeal spasm and vagally mediated reflex bronchoconstriction; IPPV, awake extubation, postoperative monitoring of respiratory function and appropriate analgesia.