Study reveals risk factors for peri-operative respiratory events in children
MedWire News: A large single-center study has identified variables that place children at increased risk for peri-operative respiratory events.
"These risk factors should be explored during the pre-operative assessment in all children to establish the best anesthesia care," say Britta von Ungern-Sternberg (Princess Margaret Hospital for Children, Perth, Australia) and colleagues.
As reported in The Lancet, the researchers assessed completed adapted International Study Group for Asthma and Allergies in Childhood questionnaires for 9297 children who underwent surgery at their institution.
The anesthesiologists in charge of the children completed the questionnaires, but were not informed of the purpose of the study. In all, 15% of children suffered respiratory complications, with this being most frequent in children undergoing urgent procedures (17%).
The risk for peri-operative respiratory events was significantly elevated in children with a positive respiratory history - defined as nocturnal dry cough, wheezing during exercise, wheezing more than three times in the past 12 months, or a history of eczema - relative to those without.
Specifically, the risk for bronchospasm was increased 8.46 fold, the risk for laryngospasm was elevated 4.13 fold, and the risk for cough, desaturation, or airway obstruction was increased 3.05 fold.
Upper respiratory tract infection raised the risk for respiratory events about two fold if the children had symptoms at the time of surgery or within the preceding 2 weeks. Children with symptoms that occurred 2-4 weeks before surgery had a 34% reduction in risk relative to those without respiratory tract infection.
Children also had an elevated risk for respiratory events if at least two family members suffered asthma or atopy, or smoked.
Among children with good physical status, ie, those with an American Society of Anesthesiologists (ASA) 1 rating, a positive history of respiratory events was associated with increased rates of respiratory complications, at 27% versus 8% in those without such a history. The same was true for children with ASA 2 and 3, but not for those with ASA 4.
Anesthesia variables also influenced the children's risk for respiratory events, with use of intravenous versus inhalation induction, inhalation versus intravenous maintenance, and face mask versus tracheal intubation reducing risk. The likelihood of respiratory events was also reduced if the children received airway management from a specialist pediatric anesthesiologist rather than a registrar.
In an accompanying commentary, Jerrold Lerman (Women and Children's Hospital of Buffalo, New York, USA) said that anesthetic practice in the study center appeared to differ from that in other urban practices.
For example, he said that, in his experience, surgery is postponed if children have current symptoms of upper respiratory tract infection, which did not appear to occur in the study center.
Lerman concluded: "Today's study adds an interesting perspective to our understanding of peri-operative respiratory adverse events in a cross-section of children undergoing surgery, although its external validity might be challenged and the reproducibility of several findings requires further research."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Eleanor McDermid