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Respiratory Illnesses and Their Influence on Anesthesia in Children

  • Britta von Ungern-SternbergEmail author
  • David Sommerfield
Chapter

Abstract

Adverse respiratory events are a major cause of morbidity and mortality from general anesthesia in children. Established risk factors include upper respiratory tract infection (URTI) in the previous 2 weeks, wheezing more than three times during the previous year, a history of asthma, cystic fibrosis, bronchopulmonary dysplasia or other lung disease, eczema, family history of atopy, and exposure to passive smoking. Many of these are markers of underlying airway inflammation, which can lead to airway irritability and bronchial hyper-reactivity. Age is another factor, and infants have double the risk compared to older children. Airway, cardiac or upper abdominal surgeries also increase risk. Premedication with midazolam is associated with increased risk (OR 3.5), while alpha-2 adrenergic agonists are theoretically better. Salbutamol premedication reduces respiratory events in young children with URTI, children undergoing tonsillectomy and in those with multiple risk factors. Intravenous induction, and possibly maintenance with propofol, reduces risk compared to a volatile anesthetic technique. The least invasive suitable airway is preferred for the child with an irritable airway. For example in infants, the laryngeal mask is associated with a lower risk of perioperative respiratory events compared with endotracheal intubation (RR 2·94). Children with multiple risk factors or active symptoms may benefit from deep removal of their endotracheal tube or supraglottic airway. Finally, care by a specialist pediatric anesthetist has been shown to decrease the risk for respiratory events.

Keywords

Asthma and anesthesia Bronchospasm during anesthesia children Upper respiratory tract infection and anesthesia children Anesthesia for cystic fibrosis Airway irritability during anesthesia 

Further Reading

Asthma

  1. Doherty GM, et al. Anesthesia and the child with asthma. Paediatr Anaesth. 2005;15:446–54.CrossRefGoogle Scholar
  2. Guill MF. Asthma update: epidemiology and pathophysiology (part 1). Pediatr Rev. 2004;25:299–305.CrossRefGoogle Scholar
  3. Regli A, von Ungern-Sternberg B. Anesthesia and ventilation strategies in children with asthma: part I & II. Curr Opin Anaesthesiol. 2014;27:288–94, 295–302.CrossRefGoogle Scholar
  4. Trend S, et al. Current options in aerosolised drug therapy for children receiving respiratory support. Anesthesia. 2017;72:1388–97.CrossRefGoogle Scholar

URTI

  1. Cote CJ. The upper respiratory tract infection dilemma: fear of a complication or litigation? Anesthesiol. 2001;95:283–5. An excellent editorial that discusses the overarching issue of balancing risks with various reality factors when presented with children with a recent URTI needing anesthesia.CrossRefGoogle Scholar
  2. Parnis S, Barker DS, Van Der Walt JH. Clinical predictors of anesthetic complications in children with respiratory tract infections. Pediatr Anesth. 2001;11:29–40.CrossRefGoogle Scholar
  3. Regli A, Becke K, von Ungern-Sternberg BS. An update on the perioperative management of children with upper respiratory tract infections. Curr Opin Anaesthesiol. 2017;30:362–7.CrossRefGoogle Scholar
  4. von Ungern-Sternberg BS, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet. 2010;376:773–83.CrossRefGoogle Scholar

Bronchiolitis

  1. Zorc JJ, Hall CB. Bronchiolitis: Recent evidence on diagnosis and management. Pediatr Rev. 2010;125:342–9. A review that gives detailed information about pathophysiology and medical management. Anesthesia issues are not discussed.Google Scholar

Cystic Fibrosis

  1. Cutting G. Cystic fibrosis genetics: from molecular understanding to clinical application. Nat Rev. Genet. 2015;16:45–56.CrossRefGoogle Scholar
  2. Della Rocca G. Anesthesia in patients with cystic fibrosis. Curr Opin Anesthesiol. 2002;15:95–101.CrossRefGoogle Scholar
  3. Pandit C, Valentin R, De Lima J. Effect of general anesthesia on pulmonary function and clinical status on children with cystic fibrosis. Pediatr Anesth. 2014;24:164–9.CrossRefGoogle Scholar

OSA

  1. Gipson K, Lu M. Sleep-disordered breathing in children. Pediatr Rev. 2019;40:3–13. An excellent review of the causes, diagnosis and management of OSA in children.CrossRefGoogle Scholar
  2. Scalzitti N, Sarber K. Diagnosis and perioperative management in pediatric sleep disordered breathing. Pediatr Anesth. 2018;28:940–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Britta von Ungern-Sternberg
    • 1
    • 2
    Email author
  • David Sommerfield
    • 1
  1. 1.Department of Anaesthesia and Pain ManagementPerth Children’s HospitalNedlandsAustralia
  2. 2.Medical School, The University of Western AustraliaPerthAustralia

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