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Do children who experience laryngospasm have an increased risk of upper respiratory tract infection?
M S Schreiner1, I O'Hara, D A Markakis
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA. Schreiner@Email.CHOP.edu
Insights
Children with active upper respiratory infections are more likely to experience laryngospasm during surgery. This risk is also elevated in younger children, those undergoing airway surgery, or those with less experienced anesthesiologists.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Laryngospasm is a common respiratory complication in pediatric anesthesia.
- Previous retrospective studies suggested a link with upper respiratory infections, but prospective data were lacking.
Purpose of the Study:
- To investigate the association between upper respiratory infection (URI) and laryngospasm in children undergoing surgery.
- To identify risk factors for laryngospasm in pediatric patients.
Main Methods:
- A case-control study involving 15,183 pediatric patients admitted through a day surgery unit.
- Parental reporting of active or recent URI and specific symptoms was used to define URI.
- Control subjects were matched based on the timing of surgery.
Main Results:
- Children with laryngospasm were over twice as likely to have an active URI (OR=2.05, 95% CI 1.21-3.45).
- Younger age (OR=0.92), airway surgery (OR=2.08), and less experienced anesthesiologists (OR=1.69) were also associated with increased laryngospasm risk.
- Laryngospasm was not linked to recent URI or a specific clinical definition of URI.
Conclusions:
- Active URI is a significant risk factor for laryngospasm in pediatric surgical patients.
- Clinicians should consider patient age, surgical procedure, and anesthesiologist experience when assessing the risk of anesthesia in children with URI.
Background:
Laryngospasm is the most frequently reported respiratory complication associated with upper respiratory infection and general anesthesia in retrospective studies, but prospective studies have failed to demonstrate any increase in risk.
Methods:
A case-control study was performed to examine whether children with laryngospasm were more likely to have an upper respiratory infection on the day of surgery. The parents of all patients (N = 15,183) who were admitted through the day surgery unit were asked if their child had an active or recent (within 2 weeks of surgery) upper respiratory infection and were questioned about specific signs and symptoms to determine if the child met Tait and Knight's definition of an upper respiratory infection. Control subjects were randomly selected from patients whose surgery had occurred within 1 day of the laryngospasm event.
Results:
Patients who developed laryngospasm (N = 123) were 2.05 times (95% confidence interval 1.21-3.45) more likely to have an active upper respiratory infection as defined by their parents than the 492 patients in the control group (P < or = 0.01). The development of laryngospasm was not related to Tait and Knight's definition for an upper respiratory infection or to recent upper respiratory infection. Children with laryngospasm were more likely to be younger (odds ratio = 0.92, 95% confidence interval 0.87-0.99), to be scheduled for airway surgery (odds ratio = 2.08, 95% confidence interval 1.21-3.59), and to have their anesthesia supervised by a less experienced anesthesiologist (odds ratio = 1.69, 95% confidence interval 1.04-2.7) than children in the control group.
Conclusion:
Laryngospasm was more likely to occur in children with an active upper respiratory infection, children who were younger, children who were undergoing airway surgery, and children whose anesthesia were supervised by less experienced anesthesiologists. Understanding the risk factors and the magnitude of the likely risk should help clinicians make the decision as to whether to anesthetize children with upper respiratory infection.