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Perioperative management for childhood asthma
1Division of Allergy, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
Insights
Asthmatic children undergoing surgery rarely experience intraoperative bronchospasm when properly prepared. This study found a low incidence, suggesting proactive management mitigates risks for pediatric asthma patients.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Critical Care
Background:
- Asthma in children is linked to increased intraoperative bronchospasm risk.
- Existing research primarily addresses this issue in adult populations.
- This study focuses on the perioperative experience of pediatric asthma patients.
Purpose of the Study:
- To determine the actual incidence of perioperative bronchospasm in children with asthma.
- To validate or refute the suggested high likelihood of bronchospasm in pediatric patients with reactive airways disease.
Main Methods:
- Retrospective chart review of 386 asthmatic children and 51 with bronchopulmonary dysplasia (1987-1992).
- Asthma severity classified as mild, moderate, or severe based on clinical indicators.
- Individualized asthma management plans were implemented preoperatively.
Main Results:
- Only 3 out of 437 children (0.13%) experienced intraoperative bronchospasm over five years.
- The observed cases of bronchospasm were readily managed with beta-2 agonists.
- No routine use of blood gases, chest radiographs, or pulmonary function studies.
Conclusions:
- Appropriately prepared asthmatic children do not face an elevated risk of adverse outcomes during surgery.
- Children requiring more than inhaled beta-2 agonists often had recent asthma exacerbations, viral infections, or hospitalizations.
- Effective preoperative asthma management is key to minimizing perioperative complications.
Background:
Children with asthma have been reported to be at increased risk for intraoperative bronchospasm. Current medical literature focuses on this problem in adult patients. This is a report of our experience in children.
Objective:
The purpose of this study was to discern whether children with reactive airways disease (asthma) actually had a high likelihood of perioperative bronchospasm as the medical literature suggests.
Methods:
A retrospective chart review of 386 asthmatic children and 51 with bronchopulmonary dysplasia seen perioperatively between 1987 and 1992 was instituted. Children with asthma were classified as mild, moderate or severe based on the number of hospitalizations, emergency room visits, intensive care unit admissions and medications at the time of evaluation. Patients with bronchopulmonary dysplasia were included in a separate category. Individualized asthma management was recommended for all patients in preparation for surgery. Blood gases, chest radiographs and pulmonary function studies were not routinely ordered.
Results:
Only 3 of 437 children in a five-year period (0.13%) had intraoperative bronchospasm, easily controlled with the use of beta-2 agonists.
Conclusions:
This study demonstrates that asthmatic children appropriately prepared for surgery do not appear to have an increased risk for adverse outcome. The children treated with more than inhaled beta-2 agonists were those who had more severe asthma, recent viral infection, recent exacerbation of asthma, or recent hospitalization for asthma.