TY - JOUR
T1 - Preoperative preparation of children with upper respiratory tract infection
T2 - a focussed narrative review
AU - Stepanovic, Bojana
AU - Regli, Adrian
AU - Becke-Jakob, Karin
AU - von Ungern-Sternberg, Britta S.
N1 - Publisher Copyright:
© 2024 British Journal of Anaesthesia
PY - 2024/10/1
Y1 - 2024/10/1
N2 - This review summarises the current evidence for the perioperative preparation in children with upper respiratory tract infections (URTI), including COVID-19 infection. URTI, including COVID-19 infection, are common and frequent in children who present for elective surgery. Children with URTI are at increased risk of perioperative respiratory adverse events. Perioperative respiratory adverse events are among the most serious and impactful consequences of paediatric anaesthesia, including cardiorespiratory arrest, and therefore present a significant challenge for the paediatric anaesthetist. This review addresses the pathophysiology and time course of URTI, including COVID-19. The evidence-based patient, anaesthetic, and surgical risk factors for perioperative respiratory adverse events are summarised. These risk factors work synergistically to determine individual patient risk and allow for risk stratification both clinically and with validated scoring systems. Evidence-based optimisation of modifiable respiratory risk factors can reduce the risk of perioperative bronchospasm. The evidence for the anaesthesia management options, including the timing and setting of surgery, experience of the paediatric anaesthetist, premedication, choice of airway device, choice of agent for induction and maintenance of anaesthesia, and deep vs awake tracheal extubation techniques along with a risk stratification framework are discussed.
AB - This review summarises the current evidence for the perioperative preparation in children with upper respiratory tract infections (URTI), including COVID-19 infection. URTI, including COVID-19 infection, are common and frequent in children who present for elective surgery. Children with URTI are at increased risk of perioperative respiratory adverse events. Perioperative respiratory adverse events are among the most serious and impactful consequences of paediatric anaesthesia, including cardiorespiratory arrest, and therefore present a significant challenge for the paediatric anaesthetist. This review addresses the pathophysiology and time course of URTI, including COVID-19. The evidence-based patient, anaesthetic, and surgical risk factors for perioperative respiratory adverse events are summarised. These risk factors work synergistically to determine individual patient risk and allow for risk stratification both clinically and with validated scoring systems. Evidence-based optimisation of modifiable respiratory risk factors can reduce the risk of perioperative bronchospasm. The evidence for the anaesthesia management options, including the timing and setting of surgery, experience of the paediatric anaesthetist, premedication, choice of airway device, choice of agent for induction and maintenance of anaesthesia, and deep vs awake tracheal extubation techniques along with a risk stratification framework are discussed.
KW - adverse events
KW - bronchospasm
KW - COVID-19
KW - paediatric anaesthesia
KW - respiratory tract infections
KW - risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85205376567&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2024.07.035
DO - 10.1016/j.bja.2024.07.035
M3 - Review article
AN - SCOPUS:85205376567
SN - 0007-0912
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
ER -