Anesthesia in children with a cold

Becke, Karin

doi:10.1097/aco.0b013e3283534e80

Cited by 63 publications

(59 citation statements)

References 41 publications

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“…Perioperative respiratory adverse events are a major cause of morbidity and mortality and are the cause of up to 30% of perioperative cardiac arrests in the pediatric population during anesthesia . Independent risk factors for perioperative respiratory adverse events have been identified in several studies and include: age less than 6 years old, a recent (<4 weeks) and currently active upper respiratory infection (URI), a primary pulmonary morbidity (such as asthma, prematurity, bronchopulmonary dysplasia, cystic fibrosis, pulmonary hypertension, etc.…”

Section: Introductionmentioning

confidence: 99%

“…There is currently no widely utilized algorithm to determine perioperative risks in deciding whether to proceed or delay surgery and anesthesia, a few have been suggested . Although blanket cancelation of surgery because of a URI avoids the potential for complications, it may also impose social, emotional, economic consequences on the child, the family, as well as the medical team and may not always be necessary . An accurate preanesthetic assessment of the risks of perioperative respiratory adverse event would enable risk stratification prior to surgery and reduce the likelihood of complications.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative respiratory adverse event risk assessment in children with upper respiratory tract infection: Validation of the COLDS score

Lee

Bernardo

Grogan

et al. 2018

Pediatric Anesthesia

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Summary Background The decision to proceed with anesthesia and surgery has been controversial in pediatric patients with an upper respiratory tract infection. The COLDS score was proposed by Lee and August as a potential risk stratification scheme, but no validation has been performed on this scale. Aims The aim of this study was to evaluate the utility of the COLDS score in predicting perioperative respiratory adverse events and optimize its predictive ability. Methods COLDS scores, incidence of perioperative respiratory adverse events, surgical procedure type, and age were prospectively collected for 536 patients who met inclusion criteria. Area under the receiver operating characteristic curves was computed for total COLDS score and individual COLDS score categories. Multivariable regression was used create an optimized score. To quantify the decrease in risk associated with case cancelation due to illness, the other risk factors in COLDS were assessed separately from upper respiratory infection status and a risk model was created. Results The area under the receiver operating characteristic curve for the total COLDS score was 0.69, suggesting that the COLDS score has a moderate predictive ability for perioperative respiratory adverse events. When split into individual component scores, the area under the receiver operating characteristic curve ranged from 0.55 to 0.63. We also found that the area under the receiver operating characteristic curve for the scoring system was higher in younger children than for children aged 4‐6 (area under receiver operating characteristic curve of 0.70‐0.71 vs 0.66). The area under the receiver operating characteristic curve for the optimized scoring system was 0.71. Conclusion The COLDS score has the potential to be a valuable risk assessment tool for prediction of perioperative respiratory adverse events and appears to have a better predictive value in certain subpopulations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perioperative respiratory adverse event risk assessment in children with upper respiratory tract infection: Validation of the COLDS score

Lee

Bernardo

Grogan

et al. 2018

Pediatric Anesthesia

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“…Although several cohort-based studies have shown a correlation between URI symptoms and perioperative respiratory adverse events, the complications listed were usually mild and easily managed by a competent pediatric team with no long-term sequelae. 22 Furthermore, the listed adverse events (oxygen desaturation up to 92%-95%, laryngospasm, persistent cough, bronchospasm, and airway obstruction) were qualitatively similar to those in pediatric patients who were free of URI symptoms. [23][24][25] In a recent large prospective risk-assessment study, URI was associated with an increased risk for perioperative respiratory adverse events only when symptoms were active or when the URI had occurred in the 2 weeks before the procedure.…”

Section: The Pediatric Ambulatory Patientmentioning

confidence: 83%

An analysis of risk factors and adverse events in ambulatory surgery

Kent¹,

Metzner²

2014

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Care for patients undergoing ambulatory procedures is a broad and expanding area of anesthetic and surgical practice. There were over 35 million ambulatory surgical procedures performed in the US in 2006. Ambulatory procedures are diverse in both type and setting, as they span the range from biopsies performed under local anesthesia to intra-abdominal laparoscopic procedures, and are performed in offices, freestanding ambulatory surgery centers, and ambulatory units of hospitals. The information on adverse events from these varied settings comes largely from retrospective reviews of sources, such as quality-assurance databases and closed malpractice claims. Very few if any ambulatory procedures are emergent, and in comparison to the inpatient population, ambulatory surgical patients are generally healthier. They are still however subject to most of the same types of adverse events as patients undergoing inpatient surgery, albeit at a lower frequency. The only adverse events that could be considered to be unique to ambulatory surgery are those that arise out of the circumstance of discharging a postoperative patient to an environment lacking skilled nursing care. There is limited information on these types of discharge-related adverse events, but the data that are available are reviewed in an attempt to assist the practitioner in patient selection and discharge decision making. Among ambulatory surgical patients, particularly those undergoing screening or cosmetic procedures, expectations from all parties involved are high, and a definition of adverse events can be expanded to include any occurrence that interrupts the rapid throughput of patients or interferes with early discharge and optimal patient satisfaction. This review covers all types of adverse events, but focuses on the more severe adverse events that are associated with morbidity requiring unplanned admission to hospital and mortality.

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“…Epistaxis can occur even when vasoconstrictors, lubrication, and careful manipulation are used. Among others, severe hemorrhage, blood draining down the pharynx [13,14], nasal or nasopharyngeal mucosa damage [15], and tracheal or esophageal trauma may lead to serious complications such as pneumothorax or infection [16][17][18]. Adenoids, polyps, and foreign bodies may be displaced, causing bleeding and even airway obstruction.…”

Section: Discussionmentioning

confidence: 99%