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Evaluación del riesgo de complicaciones respiratorias en la anestesia pediátrica: un estudio de cohorte prospectivo
Britta S von Ungern-Sternberg1, Krisztina Boda, Neil A Chambers
1Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, WA, Australia. bvonungern@uhbs.ch
Lancet (London, England)
|September 7, 2010
Resumen
Los niños con antecedentes de problemas respiratorios o asma familiar enfrentan mayores riesgos de eventos adversos respiratorios perioperatorios. La administración de anestesia dirigida puede mitigar estos riesgos, mejorando la seguridad de la anestesia pediátrica.
Área de la Ciencia:
- Anestesiología Pediátrica Anestesiología Pediátrica.
- Medicina de las vías respiratorias Medicina de las vías respiratorias
- Gestión de riesgos clínicos Gestión de riesgos clínicos.
Sus antecedentes:
- Los eventos adversos respiratorios perioperatorios son una causa significativa de morbilidad y mortalidad en la anestesia pediátrica.
- La identificación de los factores de riesgo es crucial para mejorar los resultados de los pacientes.
Objetivo del estudio:
- Investigar las asociaciones entre los antecedentes familiares, el manejo de la anestesia y la aparición de eventos adversos respiratorios perioperatorios en niños.
- Para identificar a los niños en alto riesgo de estos eventos.
Principales métodos:
- Estudio prospectivo de 9297 niños sometidos a anestesia general.
- Datos recopilados a través del cuestionario adaptado del Grupo de Estudio Internacional para el Asma y las Alergias en la Infancia.
- Incluido el historial médico familiar, los síntomas respiratorios y los detalles del manejo de la anestesia.
Principales resultados:
- Los antecedentes respiratorios positivos (por ejemplo, tos, sibilancias, eczema) aumentaron significativamente el riesgo de broncoespasmo, laringospasmo y obstrucción de las vías respiratorias.
- Las infecciones recientes del tracto respiratorio superior (IRTU) aumentaron el riesgo, mientras que las IRTU de 2 a 4 semanas antes disminuyeron el riesgo.
- Los antecedentes familiares de asma/atopía/tabaco y técnicas específicas de anestesia (por ejemplo, inducción por inhalación, uso de máscaras faciales) se asociaron con un aumento de los riesgos.
Conclusiones:
- Los niños con alto riesgo de eventos adversos respiratorios perioperatorios pueden ser identificados durante la evaluación preanestésica.
- Las estrategias de gestión de la anestesia personalizadas pueden mejorar la seguridad de estos niños de alto riesgo.
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