Risk factors for adverse respiratory side effects in children during anaesthesia include respiratory symptoms, eczema, and a family history of asthma, rhinitis, eczema, and exposure to tobacco smoke. These risk factors are easily identified by a risk assessment questionnaire that could be used in everyday clinical practice to optimise anaesthesia care for every child. These are the findings of an Article published Online First and in this week's edition of The Lancet, written by Britta S von Ungern-Sternberg from the Princess Margaret Hospital for Children, Subiaco, Australia, and international colleagues.
Respiratory adverse events are one of the main causes of complications and death during anaesthesia in children. Previous research has reported some risk factors that increase the likelihood of these adverse events, although most studies have focused on a specific condition or population. Accurate assessment of the likelihood of complications could enable children to benefit from tailored anaesthetic management.
In this study, the researchers identified risk factors for the occurrence of perioperative respiratory adverse events in children given general anaesthesia for surgical or medical interventions at the Princess Margaret Hospital for Children in Australia, between February 2007 and January 2008. Anaesthetists used an adapted version of the International Study Group for Asthma and Allergies Childhood (ISAAC) questionnaire to collect information on family medical history on the day of surgery. The researchers analysed data for over 10 000 children (9297 questionnaires) and their anaesthesia management, along with the occurrence of respiratory complications.
A positive respiratory history (recent cold, wheezing during exercise, wheezing more than three times in the past 12 months, nocturnal dry cough, and eczema), present or recent (less than 2 weeks) upper respiratory tract infection, eczema, and a history of asthma, atopy, smoking, rhinitis, or eczema in at least two family members, were associated with increased risk of respiratory adverse events, including the potentially life threatening complications bronchospasm and laryngospasm.Other predictors of poor outcome included anaesthesia management by a registrar instead of a specialist paediatric anaesthetist and inhalational compared with intravenous anaesthesia.
For the first time, the effects of smoking habits of different family members on the risk of respiratory adverse events was shown—the risk was higher when children were exposed to maternal smoking or both parents smoking, than when only the father smoked.
Interestingly, a positive respiratory history seemed more accurate at predicting the occurrence of respiratory adverse events than The American Society of Anaesthesiologists (ASA) physical status system that is currently used to assess the likelihood of complications in children during anaesthesia.
The authors conclude: "Children at high risk for perioperative respiratory adverse events could be systematically identified at the preanaesthetic assessment and thus can benefit from specifically targeted anaesthesia management."
In a Comment, Jerrold Lerman from the Woman and Children's Hospital of Buffalo, NY, USA, says: "Today's study adds an interesting perspective to our understanding of perioperative 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…Randomised trials are required to evaluate and validate the contributions of some subpopulations and management strategies to the frequency of perioperative respiratory adverse events."
Professor Britta S von Ungern-Sternberg,Princess Margaret Hospital for Children, Subiaco, WA, Australia. T) +61 8 9340 8222 E) britta.regli-vonungern@health.wa.gov.au
Dr Jerrold Lerman, Women and Children's Hospital of Buffalo, Buffalo, NY, USA. T) +1 716 878 7701 E) jerrold.lerman@gmail.com
For full Article and Comment see: http://press.thelancet.com/paedanaes.pdf
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Journal
The Lancet