Anesthesia for the child with a recent upper respiratory infection
- Philipp Houck, MD
Philipp Houck, MD
- Assistant Professor of Anesthesiology
- Columbia University Medical Center
Upper respiratory infection (URI) is the most frequent human illness and the most common infection in childhood; infants and preschoolers have six to eight URIs per year . Thus, children commonly present for surgery and anesthesia with a current or recent URI, with potential for increased risk for perioperative respiratory adverse events.
This topic will discuss the preoperative assessment of children with a current or recent URI, as well as intraoperative anesthesia management. Diagnosis, treatment, prevention, and complications of URIs in children are discussed separately. (See "The common cold in children: Clinical features and diagnosis" and "The common cold in children: Management and prevention".)
The term "upper respiratory infection" (URI) may be used to describe a variety of infections. For the purposes of this topic, URI is meant to refer to a constellation of signs and symptoms otherwise called "the common cold," an acute viral infection of the upper respiratory tract involving, to variable degrees, sneezing, nasal congestion and discharge (rhinorrhea), sore throat, cough, low-grade fever, headache, and malaise.
RISKS OF ANESTHESIA FOR THE CHILD WITH AN UPPER RESPIRATORY INFECTION
Multiple studies have shown that children who undergo general anesthesia with a current or recent upper respiratory infection (URI) are at increased risk of perioperative respiratory adverse events (PRAEs), mostly related to airway hyperreactivity, though most of these events are mild and easily managed [2-8]. Perioperative respiratory events increase admission rates and costs and prolong hospitalizations , but long-term consequences of brief oxygen desaturations have not be demonstrated .
PRAEs include laryngospasm, bronchospasm, atelectasis, coughing, airway obstruction, hypoxia, stridor, and breathholding. Though most PRAEs are easily managed, more significant events can occur. According to data from the Pediatric Perioperative Cardiac Arrest Registry, after cardiovascular causes, respiratory events were the second-most common cause of perioperative cardiac arrests in children, with laryngospasm being the most likely cause for respiratory-induced cardiac arrests [11,12].
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- RISKS OF ANESTHESIA FOR THE CHILD WITH AN UPPER RESPIRATORY INFECTION
- Time course of PRAE risk
- Risk of PRAEs
- Other risk factors for PRAEs
- - Choice of airway device
- The COLDS score
- PREOPERATIVE EVALUATION
- Physical examination
- Laboratory and radiologic examination
- Timing of elective procedures
- PREOPERATIVE OPTIMIZATION
- Inhaled short-acting beta-2 agonist
- Nasal decongestant
- Chest physical therapy
- ANESTHESIA MANAGEMENT
- Airway management
- Induction and maintenance of anesthesia
- Ventilation during anesthesia
- Intraoperative airway events
- - Laryngospasm
- - Bronchospasm
- POSTOPERATIVE CONCERNS
- SUMMARY AND RECOMMENDATIONS