Children with recent colds linked to respiratory events

Children undergoing general anesthesia for surgery or other procedures are more likely to have adverse respiratory events if they recently had a cold or other upper respiratory infection (URI).1

The November issue of Anesthesiology presents the first large study to look at how recent URIs affect the risk of adverse respiratory events in children receiving anesthesia using the laryngeal mask airway (LMA). The overall risk is low and serious complications are rare when anesthesia is delivered with this method. However, the results suggest that waiting two weeks after a URI may make anesthesia even safer.

"Our results will help anesthesiologists in planning the anesthesia management of children with recent upper respiratory tract infection, says Walid Habre, MD, PhD, one of the study authors and senior lecturer and head of the Pediatric Anesthesia Unit at Geneva (Switzerland) Children's Hospital, University Hospital.

Over five months, researchers asked parents of children undergoing surgery to provide information on recent URIs, such as colds, sinusitis, or tonsillitis. All of the children were given general anesthesia via an LMA for their procedures.

According to the parents, 27% of children had had a URI in the previous two weeks. Children with recent URIs were about twice as likely to develop certain adverse respiratory events. Overall, 20% of children had episodes of desaturation requiring oxygen administration in the recovery room. Although these events were more frequent in children with recent URIs, they were no more severe. Children with URIs also had a greater rate of laryngospasm. Children with recent URIs were also at almost double the risk of problems with coughing after their procedure.

All respiratory events were more common in younger children and in children undergoing surgery on the ear, nose, and throat. Adverse events also were more frequent when more than one attempt was needed to insert the LMA device in the mouth.

The risks of proceeding with surgery are not well known due to limited evidence on how long one must wait after a URI for the risk to drop to normal. The researchers emphasize that the overall risk is low and that all of the events in the study were easily managed, with no lasting effects.

"Our study may help parents to better understand why anesthesiologists may prefer to postpone anesthesia for at least two weeks in children with recent URI, in order to decrease the incidence of perioperative respiratory adverse events, Habre says.

Reference

  1. Von Ungern-Sternberg BS, Boda K, Schwab C, et al. Laryngeal mask airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections. Anesthesiology 2007; 107:714-719.