202407071238
Status:
Tags: respiratory, Paed
URTI
Most studies define URTI as two or more symptoms:
- rhinorrhoea,
- sore throat,
- sneezing,
- nasal congestion,
- malaise,
- cough
- fever more than 38°C.
Airway hyper-reactivity is common after an URTI and can persist for up to 6 weeks.
Children with URTIs or within 2–4 weeks of cessation of symptoms are at increased risk of perioperative respiratory adverse events (PRAE)
While the incidence of serious events is low, children have a two- to seven fold increased risk of laryngospasm, bronchospasm and hypoxaemia, and an 11-fold risk if their trachea is intubated.
Risk factors a/w PRAE
URTI-related factors
- Fever (>38°C)
- Purulent & copious secretions
- Malaise, lethargy, decreased appetite
- Lower respiratory tract signs
- Respiratory syncytial virus.
Child factors
- Age <1 year
- History of prematurity
- Sickle cell disease
- History of snoring/sleep-disordered breathing
- History of reactive airway disease
- History of other pulmonary comorbidities,
- e.g. bronchopulmonary dysplasia, cystic fibrosis
- Parent's perception of child ‘having a cold’/‘being sick’
- Parental smoking.
Anaesthesia and surgery factors
- airway instrumentation
- (endotracheal tube (ETT) > supraglottic airway (SGA) > face mask)
- airway surgery
- inhalational induction
- major surgery
- anaesthetist with limited paediatric anaesthesia experience
- facility with limited paediatric exposure.
Children with noteworthy URTI symptoms, especially if they have any other risk factor, should have elective surgery deferred for at least 2 weeks if possible
Anaesthetic Mx
Suction of the airway is frequently required prior to extubation
Desflurane is usually avoided to reduce risk of airway irritation and intravenous (IV) induction may be generally preferred
Respiratory medications such as bronchodilators should be continued pre-operatively
Other strategies
- Avoid use of benzodiazepines for premedication, if required consider using α-2 agonist (clonidine or dexmedetomidine).
- Give preoperative inhaled salbutamol 10–30 minutes before surgery
- Consider IV lignocaine to suppress laryngospasm but avoid topical lignocaine to vocal cords.
- There is no evidence that an anti-sialagogue or anticholinergic reduces incidence of adverse events.
- Deep extubation or SGA removal might reduce the risk of respiratory adverse events but might increase the risk of airway obstruction