Anesthesia in children with a cold

Preoperative nebulised lidocaine for children with mild symptoms of upper respiratory tract infections: A randomised controlled trial

Nebulised lidocaine was previously used in infants and children undergoing flexible bronchoscopy and was safe and beneficial. The aim of this randomised controlled trial was to assess the impact of preoperative nebulised lidocaine on the incidence of perioperative respiratory adverse events in children aged one to five years proposed for ilioinguinal ambulatory surgery while having mild symptoms of upper respiratory tract infection. Patients were randomly allocated to one of the two groups of the study: Group L (lidocaine) received 4 mg/kg of nebulised lidocaine 2% (0.2 ml/kg), and Group P (placebo) received 0.2 ml/kg of normal saline nebulisation, 30 minutes before anaesthesia. Nebulised lidocaine reduced the risk of bronchospasm, with p = 0.003 and a risk ratio (RR) = 0.326 [0.140-0.760], and prolonged oxygen support postoperatively, with p = 0.004 and RR = 0.222 [0.067-0.732]. It also reduced the risk of hospitalisation, with p = 0.001 and RR = 0.138 [0.033-0.577]. No side effects for nebulised lidocaine 2% were noted. Preoperative nebulised lidocaine seems to be a safe and efficient premedication for children with upper respiratory tract infections.

Association of upper respiratory tract infection with perioperative respiratory adverse events in pediatric tonsillectomy patients : A propensity-matched cohort study

BACKGROUND

Upper respiratory tract infections (URTIs) and perioperative respiratory adverse events (PRAEs) pose significant risks for anesthesia in children undergoing tonsillectomy. This study aimed to determine whether URTIs is associated with PRAEs during postanesthesia recovery after tonsillectomy.

METHODS

Children underwent tonsillectomy, with or without adenoidectomy at Shanghai Children's Hospital from 1 October 2022 to 30 July 2023. We assessed associations between URTIs and PRAEs during postanesthesia recovery in pediatric patients. In total, 94 patients with URTIs were propensity score-matched 1:1 with 94 patients without URTIs. The study's main outcome measure was the difference in PRAEs incidence between the two groups.

RESULTS

Children with URTIs were more likely to experience PRAEs than those without URTIs (68 of 94 [72.3%] vs. 25 of 94 [26.6%]; odds ratio [OR], 7.44; 95% CI, 3.34-17.38). They were also more likely to require interventional management post-PRAEs in the post-anesthesia care unit, such as jaw support (OR, 5.01; 95% CI, 2.06-12.20) and mask-assisted oxygenation (OR, 7.85; 95% CI, 3.98-15.50), but no other serious clinical adverse events were observed.

CONCLUSIONS

Children with URTIs had an increased incidence of PRAEs, but only minor interventions were needed to relieve symptoms without serious adverse events. Most children can be safely anesthetized even with URTIs if perioperative anesthesia management is optimized.

TRIAL REGISTRATION

The study protocol was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2400084682) on 22 May 2024. https://www.chictr.org.cn/showproj.html?proj=230630 .

Systematic Review and Meta-Analysis Showed That Asymptomatic Viral Respiratory Infections Were Common Among Children Who Underwent Surgery

AIM

This study investigated asymptomatic viral respiratory tract infections in children who had undergone surgery and their impact on postoperative outcomes.

METHODS

A systematic literature search was carried out using the PubMed and Scopus databases, from their inception to 24 May 2024, to identify papers published in English on the subject. A meta-analysis was also carried out.

RESULTS

Five studies with 2055 participants from the USA, Brazil, the Netherlands and China met the inclusion criteria. They were published from 2019 to 2023: three were prospective observational studies and two were retrospective cohort studies. Asymptomatic viral respiratory tract infections were detected in 17% of the participants. In one study, asymptomatic viral respiratory tract infections were associated with an increased risk of respiratory complications, and they were associated with an increased risk of mortality in another study. The pooled odds ratios had wide 95% confidence intervals and showed no statistically significant associations with respiratory complications, reintubation or mortality. The meta-analysis was limited by the low number and heterogeneity of the studies.

CONCLUSION

This meta-analysis showed that asymptomatic viral respiratory tract infections were common among surgical paediatric patients. The associations between asymptomatic viral infections and postoperative complications were not conclusive, due to wide confidence intervals.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews: CRD42023412102.

The selection of ventilation devices in children with mild or moderate upper respiratory tract infections: a randomised controlled trial

PURPOSE

Administering anaesthesia to children with upper respiratory tract infections (URTIs) increases the risk of perioperative respiratory adverse events (PRAEs). Several observational studies have suggested that the supraglottic airway (SGA) technique could be a potential alternative for airway management in children. This randomised controlled trial assesses whether using a SGA instead of an endotracheal tube (ETT) in children with mild or moderate URTIs affects the incidence of PRAEs.

METHODS

A total of 78 paediatric patients with mild or moderate URTIs who received either a SGA or ETT were included. Patients were monitored for adverse events such as cough, laryngospasm, bronchospasm, breath-holding, postoperative stridor or desaturation (< 90%) during the following stages: induction of anaesthesia, tube placement, surgery, tube removal and postanaesthesia care.

RESULTS

Throughout the perioperative period, 56.4% (44/78) of children experienced PRAEs. The incidence was 77.5% (31/40) in those receiving ETT and 34.1% (13/38) in those receiving SGA. The relative risk (RR) of PRAEs in children receiving SGA was 0.417 (95% CI: 0.248-0.701) compared with those receiving ETT (p < 0.001). Specifically, the incidence of minor PRAEs was significantly lower in the SGA group (28.9%, 11/38) compared with the ETT group (67.5%, 27/40) (RR: 0.429, 95% CI: 0.249-0.738, p < 0.001). There were significant differences between the groups in the incidence of perioperative cough (p = 0.043) and desaturation (p = 0.031).

CONCLUSION

Using a SGA reduced the incidence of coughing, bronchospasm and oxygen desaturation, providing an acceptable alternative to ETT in children with mild or moderate URTIs.

Early versus late removal of the I-Gel in paediatric patients with mild upper respiratory tract symptoms undergoing ambulatory ilioinguinal surgery: A prospective observational study

The optimal timing of I-Gel removal in children with mild respiratory symptoms remains controversial. Consequently, we tried to assess the impact of early versus late I-Gel removal on the incidence of perioperative respiratory adverse events among children aged one to five years undergoing ambulatory surgery under general anaesthesia with I-Gel airway ventilation. The anaesthesia protocol was the same for all patients. Children were divided into two groups according to the approach of I-Gel removal (early versus late). The incidence of perioperative respiratory adverse events after the I-Gel removal was the main outcome, and a multivariable regression was performed to investigate the implication of the I-Gel removal in perioperative respiratory adverse events. According to our study, the incidence of perioperative respiratory adverse events was not correlated to the timing of I-Gel removal. However, prolonged postoperative oxygen support can be seen when the I-Gel is removed in anaesthetized children.

Association between preoperative respiratory symptoms and perioperative respiratory adverse events in pediatric patients with positive viral testing

STUDY OBJECTIVE

To determine the association between the presence of upper respiratory tract viral infection symptoms and occurrence of perioperative respiratory adverse events (PRAE) in children with positive viral screening, and to analyze the risk of PRAE in children with SARS-CoV-2 compared to non-SARS-CoV-2 infection.

DESIGN

A prospective cohort study.

SETTING

A tertiary, freestanding pediatric hospital in Dallas, Texas.

PATIENTS

Children <18 years of age with positive respiratory viral testing who underwent general anesthesia.

INTERVENTION

Measurement of incidence of PRAE and severe adverse events during the first 7 postoperative days.

MEASUREMENTS

The primary outcome was a composite of PRAE: oxygen saturation < 90% for >5 min, supplemental oxygen for >2 h after anesthesia, laryngospasm, and bronchospasm. The secondary outcome was severe adverse events: high flow nasal cannula >6 l of oxygen per minute, admission to the ICU for escalation of respiratory support post-anesthetic, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death.

MAIN RESULTS

In this convenience sample of 196 children, 83 were symptomatic and 113 were asymptomatic. The risk of PRAE was similar in children with active viral symptoms and asymptomatic children (risk difference: -1.9%; 95% CI: -10.9, 7.9%), but higher among children with documented fever within 48 h of the anesthetic (risk difference: 20.8%; 95% CI: 5.3, 39.7%). The multivariable adjusted odds ratio of PRAE was 0.68 (95% CI: 0.25, 1.85) for symptomatic compared to asymptomatic patients, and 0.46 (95% CI: 0.14, 1.44) for patients with SARS-CoV-2 compared to non-SARS-CoV-2 infection.

CONCLUSIONS

There was no significant difference in the incidence of PRAE between symptomatic and asymptomatic children with laboratory confirmed viral respiratory infection, and between children with the Omicron variant of SARS-CoV-2 compared to non-SARS-CoV-2 respiratory viruses. However, the risk was increased in children with recent fever.

Predictors of perioperative respiratory adverse events among children with upper respiratory tract infection undergoing pediatric ambulatory ilioinguinal surgery: a prospective observational research

Objectives

Anesthesia for children with an upper respiratory tract infection (URI) has an increased risk of perioperative respiratory adverse events (PRAEs) that may be predicted according to the COLDS score. The aims of this study were to evaluate the validity of the COLDS score in children undergoing ilioinguinal ambulatory surgery with mild to moderate URI and to investigate new predictors of PRAEs.

Methods

This was a prospective observational study including children aged 1–5 years with mild to moderate symptoms of URI who were proposed for ambulatory ilioinguinal surgery. The anesthesia protocol was standardized. Patients were divided into two groups according to the incidence of PRAEs. Multivariate logistic regression was performed to assess predictors for PRAEs.

Results

In this observational study, 216 children were included. The incidence of PRAEs was 21%. Predictors of PRAEs were respiratory comorbidities (adjusted OR (aOR)=6.3, 95% CI 1.19 to 33.2; p=0.003), patients postponed before 15 days (aOR=4.3, 95% CI 0.83 to 22.4; p=0.029), passive smoking (aOR=5.31, 95% CI 2.07 to 13.6; p=0.001), and COLDS score of >10 (aOR=3.7, 95% CI 0.2 to 53.4; p=0.036).

Conclusions

Even in ambulatory surgery, the COLDS score was effective in predicting the risks of PRAEs. Passive smoking and previous comorbidities were the main predictors of PRAEs in our population. It seems that children with severe URI should be postponed to receive surgery for more than 15 days.

When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA

Since the eruption of the worldwide SARS-CoV-2 pandemic in late 2019/early 2020, multiple elective surgical interventions were postponed. Through pandemic measures, elective operation capacities were reduced in favour of intensive care treatment for critically ill SARS-CoV-2 patients. Although intermittent low-incidence infection rates allowed an increase in elective surgery, surgeons have to include long-term pulmonary and extrapulmonary complications of SARS-CoV-2 infections (especially "Long Covid") in their perioperative management considerations and risk assessment procedures. This review summarizes recent consensus statements and recommendations regarding the timepoint for surgical intervention after SARS-CoV-2 infection released by respective German societies and professional representatives including DGC/BDC (Germany Society of Surgery/Professional Association of German Surgeons e.V.) and DGAI/BDA (Germany Society of Anesthesiology and Intensive Care Medicine/Professional Association of German Anesthesiologists e.V.) within the scope of the recent literature. The current literature reveals that patients with pre- and perioperative SARS-CoV-2 infection have a dramatically deteriorated postoperative outcome. Thereby, perioperative mortality is mainly caused by pulmonary and thromboembolic complications. Notably, perioperative mortality decreases to normal values over time depending on the duration of SARS-CoV-2 infection.

Risk factors of postoperative pulmonary complications after primary posterior fusion and hemivertebra resection in congenital scoliosis patients younger than 10 years old: a retrospective study

Background

Postoperative pulmonary complications are common and associated with morbidity and mortality. Congenital scoliosis is a failure of vertebral formation and/or segmentation arising from abnormal vertebral development. Posterior fusion and osteotomy are necessary for these patients to prevent deterioration of spine deformity. The incidence of postoperative pulmonary complications in this specific group of patients, especially young children were unknown.

Methods

A retrospective study was conducted and electronic medical records of early-onset scoliosis patients who had primary posterior fusion and hemivertebra resection at our institution from January 2014 to September 2019 were reviewed. The demographic characteristics, the intraoperative and postoperative parameters were collected to identify the predictors of postoperative pulmonary complications.

Results

A total of 174 patients (57.5% boys) with a median age of 3 years old were included for analysis. Eighteen patients (10.3%) developed perioperative pulmonary complications and pneumonia (n=13) was the most common. History of recent upper respiratory infection was not related to postoperative pulmonary complications. Multifactorial regression analysis showed thoracoplasty was the only predictive risk factor of postoperative pulmonary complications.

Conclusions

For congenital scoliosis patients younger than 10 years old, thoracoplasty determine the occurrence of postoperative pulmonary complications. Both surgeons and anesthesiologists should pay attention to patients undergoing thoracoplasty and preventive measures are necessary.

Impact of early surgical correction or palliation of congenital heart defects in infants with symptomatic viral respiratory tract infections in the current era

OBJECTIVE

This study investigates the influence of timing of surgery among infants with congenital heart disease and active respiratory tract infections in a contemporary Western Canadian cohort.

METHODS

This was a retrospective matched cohort study of infants aged 1 week to 6 months undergoing surgical repair of congenital heart disease between 2014 and 2017. Case patients had active respiratory tract infections preoperatively and were matched to control patients based on primary heart lesion. The primary outcome was time to extubation.

RESULTS

We identified 20 cases (median age, 3.4 months [range, 2.4-4.3 months]) that were matched to 40 controls (1:2 ratio). In case patients, surgery occurred at a median of 1 day after the positive viral testing. There were no statistically significant differences between cases and controls in time to extubation (59 vs 34 hours [P = .12]), postoperative vasoactive scores at 24 hours (0 vs 0 [P = .53]), 48 hours (0 vs 0 [P = .23]), maximum vasoactive score in postoperative period (5 vs 5.5 [P = .54]), or time to hospital discharge (13 vs 12 days [P = .39]). Case patients had increased duration of total respiratory support (including noninvasive ventilation, 3.5 vs 2 days [P = .02]) and postoperative intensive care unit length of stay (5.5 vs 3 days [P = .01]).

CONCLUSIONS

Cardiac surgery on infants with congenital heart disease during an acute viral respiratory tract infection may yield a clinically relevant prolongation in time to extubation.

Rhinovirus Detection in the Nasopharynx of Children Undergoing Cardiac Surgery Is Not Associated With Longer PICU Length of Stay: Results of the Impact of Rhinovirus Infection After Cardiac Surgery in Kids (RISK) Study

OBJECTIVES

To determine whether children with asymptomatic carriage of rhinovirus in the nasopharynx before elective cardiac surgery have an increased risk of prolonged PICU length of stay.

STUDY DESIGN

Prospective, single-center, blinded observational cohort study.

SETTING

PICU in a tertiary hospital in The Netherlands.

PATIENTS

Children under 12 years old undergoing elective cardiac surgery were enrolled in the study after informed consent of the parents/guardians.

INTERVENTIONS

The parents/guardians filled out a questionnaire regarding respiratory symptoms. On the day of the operation, a nasopharyngeal swab was obtained. Clinical data were collected during PICU admission, and PICU/hospital length of stay were reported. If a patient was still intubated 3 days after operation, an additional nasopharyngeal swab was collected. Nasopharyngeal swabs were tested for rhinovirus and other respiratory viruses with polymerase chain reaction.

MEASUREMENTS AND MAIN RESULTS

Of the 163 included children, 74 (45%) tested rhinovirus positive. Rhinovirus-positive patients did not have a prolonged PICU length of stay (median 2 d each; p = 0.257). Rhinovirus-positive patients had a significantly shorter median hospital length of stay compared with rhinovirus-negative patients (8 vs 9 d, respectively; p = 0.006). Overall, 97 of the patients (60%) tested positive for one or more respiratory virus. Virus-positive patients had significantly shorter PICU and hospital length of stay, ventilatory support, and nonmechanical ventilation. Virus-negative patients had respiratory symptoms suspected for a respiratory infection more often. In 31% of the children, the parents reported mild upper respiratory complaints a day prior to the cardiac surgery, this was associated with postextubation stridor, but no other clinical outcome measures.

CONCLUSIONS

Preoperative rhinovirus polymerase chain reaction positivity is not associated with prolonged PICU length of stay. Our findings do not support the use of routine polymerase chain reaction testing for respiratory viruses in asymptomatic children admitted for elective cardiac surgery.

Risk Factors for Perioperative Respiratory Adverse Events in Children with Recent Upper Respiratory Tract Infection: A Single-Center-Based Retrospective Study

Purpose

In pediatric patients, the most common reason for delaying surgical intervention is an upper respiratory tract infection (URI). To date, there has been no consensus regarding the optimal timeframe for deferring surgery in children with URI. We conducted this study to evaluate whether a URI symptom-free period and other risk factors affect the incidence of perioperative respiratory adverse events (RAEs).

Patients and Methods

The study population included 267 pediatric patients (aged 0 to 13 years) with a recent URI episode who underwent surgery under general anesthesia. Following a retrospective review of medical records, several risk factors including a URI symptom-free period for intra- and postoperative RAEs were analyzed using univariate and multivariate logistic regression analyses.

Results

RAEs occurred in 23 of 267 patients (8.6%). Univariate analysis revealed that abnormal preoperative chest images (odds ratio [OR], 7.48; 95% confidence interval [CI], 2.46–22.68, p < 0.001) and emergency operations (OR, 2.84; 95% CI, 1.03–7.81, p = 0.04) were associated with RAEs. Four variables (abnormal preoperative chest images, emergency operations, age under 1 year and symptom-free period of 7–13 days) with a significance of <0.20 in the univariate logistic regression analysis were selected as candidate risk factors for the multivariate model. Among the four variables, abnormalities in preoperative chest images (OR, 7.60; 95% CI, 2.28–25.3, p = 0.001) and a symptom-free period of 7–13 days (OR, 0.13; 95% CI, 0.02–0.88, p = 0.04) were independently associated with RAEs in multivariate logistic regression analysis.

Conclusion

For pediatric patients who require surgery and have a recent history of URI, procedures should be performed after a URI symptom-free period of at least 1–2 weeks. Confirming the absence of abnormalities in preoperative chest images can reduce the incidence of perioperative RAEs.

Effects of nasal aspiration by the Proetz® method in pediatric patients with sinusitis

OBJECTIVE

To characterize the effects of nasal aspiration with Proetz® in peak nasal inspiratory flow (PNIF) in pediatric sinusitis (PS) patients with nasal obstruction.

METHODS

This is a non-randomized descriptive-analytical clinical trial with a quantitative approach. The sample comprised 30 children. Initially, the PNIF was measured and the Visual Analogical Scale (VAS) was used for nasal obstruction, followed by the nasal aspiration procedure. The SNOT-22 questionnaire was applied to the legal guardian of each child, and one week later, it was reapplied for the sake of follow-up.

RESULTS

16 (53.3%) patients were females and 14 (46.7%) were males, with an average age of 6.4±1.8 years (between 4 and 10 years of age). Analyses of the VAS for obstruction before the intervention revealed that 10 of the participants (33.3%) presented moderate levels, and 20 of them (66.7%) severe levels. However, after the Proetz® method was applied, all the samples (n=30) had mild levels. The PNIF significantly increased after the technique was used, with an improvement of 23.4% in mean values. There was no significant correlation between the VAS and the PNIF.

CONCLUSION

Nasal aspiration with the Proetz® method significantly improved the clinical condition of sinusitis patients with nasal obstruction according to the visual analogical scale, the PNIF, and the SNOT-22 questionnaire. No correlation between the VAS and the PNIF could be found. The study confirms the importance of non-pharmacological interventions in the treatment of sinusitis in children, thus resulting in an improvement in their quality of life.

Hot Topics in Safety for Pediatric Anesthesia

Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe.

Viral Respiratory Infection, a Risk in Pediatric Cardiac Surgery: A Propensity-Matched Analysis

OBJECTIVES

1) To describe the postoperative course and outcomes of cardiac surgery in children with perioperative viral respiratory infection, 2) to evaluate optimal surgical timing for preoperative viral respiratory infection patients, and 3) to define risk stratification.

DESIGN

Retrospective study of children undergoing cardiac surgery. Children were tested using a multiplex polymerase chain reaction (respiratory virus polymerase chain reaction) panel capturing seven respiratory viruses. Respiratory virus polymerase chain reaction testing was routinely performed in patients under 2 years old. Those with negative results yet highly suspected of viral respiratory infection after surgeries would be tested again.

SETTING

A pediatric cardiac surgical ICU of pediatric cardiac surgery department at Fuwai Hospital.

PATIENTS

Children admitted between January 1, 2014, and December 31, 2016, to perform respiratory virus polymerase chain reaction testing and cardiac surgery were included.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

A total of 2,831 patients had respiratory virus polymerase chain reaction testing, and viruses were detected in 91 patients (3.2%), including 35 preoperative and 56 postoperative. Of the 35 preoperative viral respiratory infection patients, there were 29 viral respiratory infection-resolved (patients for whom surgery was postponed until resolution of viral respiratory infection symptoms and negative respiratory virus polymerase chain reaction) and six viral respiratory infection-unresolved (who underwent cardiac surgery before resolution of symptoms and clearance of carriage) patients. Furthermore, there were seven deaths, including one in the preoperative viral respiratory infection-unresolved group and six in the postoperative viral respiratory infection group. A propensity score matching was performed to correct the selection bias and identify the comparable patient groups. Compared to their matched nonviral respiratory infection patients, viral respiratory infection-resolved patients had similar duration of mechanical ventilation and length of stay, while viral respiratory infection-unresolved patients had longer durations of postoperative mechanical ventilation (p = 0.033), PICU (p = 0.028) and hospital length of stay (p = 0.010), and postoperative viral respiratory infection patients had significantly greater duration of postoperative recovery (p < 0.001) and higher mortality (p < 0.001). Earlier diagnosis of postoperative viral respiratory infection was associated with longer mechanical ventilation duration (r = 0.422; p < 0.001). Palliative cardiac surgery was the only variable significantly associated with mortality in multivariate analysis (odds ratio, 12.0; 95% CI, 1.6-87.5; p = 0.014).

CONCLUSIONS

The preoperative-unresolved and postoperative viral respiratory infection were associated with prolonged postoperative recovery, increased severity, and mortality in children with cardiac surgeries. Our results suggested the optimal surgical timing may be after the resolution of viral respiratory infection symptoms and carriage unless the perceived benefits of early surgery outweigh the risk of death, prolonged ventilation, and PICU length of stay. Palliative surgeries were associated with increasing mortality.

Anesthesia timing for children undergoing therapeutic cardiac catheterization after upper respiratory infection: a prospective observational study

BACKGROUND

We aimed to analyze anesthesia timing and perioperative respiratory adverse event (PRAE) risk factors in children undergoing therapeutic cardiac catheterization after upper respiratory tract infection (URI).

METHODS

We prospectively included children for elective therapeutic cardiac catheterization. Parents or legal guardians were asked to complete a questionnaire on the child's demographics, tobacco exposure, and URI symptoms. PRAEs (laryngospasm, bronchospasm, coughing, airway secretion, airway obstruction, and oxygen desaturation) as well as details of anesthesia management were recorded.

RESULTS

Of 332 children, 201 had a history of URI in the preceding eight weeks. The occurrence rate of PRAEs in children with URI≤two weeks reached the highest proportion, which was higher than that in children without URI (66.3% vs. 46.6%, P=0.007). The overall incidence of PRAEs in children with URI in 3-8 weeks was significantly lower than that in children with URI in the recent ≤two weeks (49.0% vs. 66.3%, P=0.007), and similar to that in the control group (49.0% vs. 46.6%). Multivariate analysis showed association between PRAEs and type of congenital heart disease (CHD) (P<0.001), anesthesia timing (P=0.007), and age (P=0.021). Delayed schedule (two weeks after URI) minimized the risk of PRAEs to the level comparable to that observed in children without URI (OR, 1.11; 95% CI: 0.64-1.91; P=0.707).

CONCLUSIONS

If treatment is not urgent, a pediatric patient at a high risk of PRAEs will be benefit from the postponement of an interventional operation by at least two weeks after URI.

Pediatric Anesthesia Concerns and Management for Orthopedic Procedures

Anesthetic management of pediatric orthopedic patients is uniquely challenging. Approach to the pediatric patient must consider heightened preoperative anxiety and its postoperative behavioral and pain effects. Frequent respiratory infections can complicate timing of surgery and anesthetic care. Perioperative pain management usually involves a multimodal pharmacologic approach with the goal of minimizing opioid requirements. Regional anesthesia is valuable for postoperative pain control. Safety of its use in the pediatric population has been confirmed in recent studies. Included for discussion are fractures, slipped capital femoral epiphysis, club foot, and scoliosis.

Preoperative Risk Factors Associated With PACU Pediatric Respiratory Complications: An Integrative Review

PURPOSE

This article reviews state of the science of preoperative risk factors associated with postanesthesia care unit (PACU) pediatric respiratory complications.

DESIGN

An integrative review.

METHODS

A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Scopus, Cochrane, and Joanna Briggs Institute databases was performed. Thirty-one articles, published between 2006 and 2018, were appraised for quality and the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice Model.

FINDINGS

These articles were grouped into the following categories: age, American Society of Anesthesiologists status, gender, airway comorbidities, syndromes, anomalies, pulmonary comorbidities, ethnicity, obesity, neurologic comorbidities, and cardiac comorbidities.

CONCLUSIONS

Evidence identified significant preoperative and anesthesia risk factors that are associated with PACU pediatric respiratory complications. This article reveals the importance for the perioperative team to identify, assess for, communicate, and develop a management plan for pediatric respiratory complications.

Laryngeal Mask Airway Versus Other Airway Devices for Anesthesia in Children With an Upper Respiratory Tract Infection: A Systematic Review and Meta-analysis of Respiratory Complications

There is an association between upper respiratory tract infection (URTI) and an increased incidence of perioperative respiratory adverse events (PRAEs), which is a major risk for morbidity during pediatric anesthesia. The aim of the present study was to compare the risk of PRAEs among different airway devices during anesthesia in children with a URTI. A systematic review according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Only randomized clinical trials evaluating anesthesia in children with a URTI and who were submitted to any of the airway devices were included. From 1030 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical differences between laryngeal mask airway (LMA®) and endotracheal tube (ETT) regarding breath holding or apnea (risk ratio [RR], 0.82; 95% confidence interval [CI], 0.41-1.65), laryngospasm (RR, 0.74; 95% CI, 0.18-2.95), and arterial oxygen desaturation (RR, 0.44; 95% CI, 0.16-1.17). The quality of evidence was low for the first outcome and very low for the 2 other outcomes, respectively. The LMA use produced a significant reduction of cough (RR, 0.75; 95% CI, 0.58-0.96, low quality of evidence) compared with ETT. The ideal airway management in children with a URTI remains obscure given that there are few data of perioperative respiratory complications during anesthesia. This systematic review demonstrates that LMA use during anesthesia in children with URTI did not result in decrease of the most feared PRAEs. However, LMA was better than ETT in reducing cough. Further research is needed to define the risks more clearly because cough and laryngospasm have similar triggers, and both bronchospasm and laryngospasm trigger cough.

Manejo perioperatorio de niños con infección respiratoria superior

Introducción. Es frecuente que muchos niños sometidos a procedimientos con anestesia general tengan historia de infección viral respiratoria superior reciente o activa.Objetivo. Realizar una revisión narrativa acerca de las pautas de manejo anestésico para los niños con infección reciente o activa de la vía aérea superior.Materiales y métodos. Se realizó una búsqueda estructurada de la literatura en las bases de datos ProQuest, EBSCO, ScienceDirect, PubMed, LILACS, Embase, Trip Database, SciELO y Cochrane Library con los términos Anesthesia AND Respiratory Tract Infections AND Complications; Anesthesia AND Upper respiratory tract infection AND Complications; Anesthesia, General AND Respiratory Tract Infections AND Complications; Anesthesia, General AND Upper respiratory tract infection AND Complications; Anesthesia AND Laryngospasm OR Bronchospasm. La búsqueda se hizo en inglés con sus equivalentes en español.Resultados. Se encontraron 56 artículos con información relevante para el desarrollo de la presente revisión.Conclusiones. Una menor manipulación de la vía aérea tiende a disminuir la frecuencia de aparición y severidad de eventos adversos respiratorios perioperatorios. No existe evidencia suficiente para recomendar la optimización medicamentosa en pacientes con infección respiratoria superior.

Preoperative Illnesses in Children Do Not Increase the Risk of Complications After Hypospadias Repair

BACKGROUND

Preoperative illnesses might induce immunosuppression and subsequently increase morbidity after surgery. Several studies have tried to identify risk factors for complications after hypospadias correction, but effects of illnesses in the weeks just before surgery are unknown. We aimed to determine the associations between preoperative illnesses not severe enough to postpone surgery and short-term complications after hypospadias repair in children.

METHODS

In this retrospective cohort study, data were collected from 681 children with anterior or middle type hypospadias that had initial 1-stage repair in the period 1983-2012 in the Radboudumc, The Netherlands. The associations between common illnesses, such as common cold, fever and ear infection, within 2 weeks before repair, and postoperative complications, such as urethrocutaneous fistula, wound dehiscence and stenosis, within 2 months and 1 year after surgery, were analyzed using multivariable logistic regression analyses.

RESULTS

Of the 681 boys, 22% had preoperative illnesses, most often common cold, and 14% had postoperative complications. Children with preoperative illnesses had fewer postoperative complications within 2 months (n = 13, 9%) than children without preoperative illnesses (n = 79, 16%), resulting in a 50% risk reduction (odds ratio: 0.49; 95% confidence interval: 0.26-0.93). Preoperative infections (common cold, fever and ear infection), in particular, reduced the risk of postoperative infections (wound and urinary tract infections; odds ratio: 0.37; 95% confidence interval: 0.14-0.98). Results were similar for complications within 1 year.

CONCLUSIONS

Common preoperative illnesses not severe enough to postpone surgery did not increase the postoperative complication risk and even seemed to have a protective effect, especially for postoperative infections. Consequently, there is no reason to alter preoperative screening.

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

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.

Impact of upper respiratory tract infections on perioperative outcomes of children undergoing therapeutic cardiac catheterisation

BACKGROUND

Recent upper respiratory tract infection (URI) is associated with increased incidence of perioperative complications in children undergoing open heart surgery. As a result, surgery is often postponed. However, the effect of recent URI on the incidence of perioperative complications in children undergoing therapeutic cardiac catheterisation is unknown. We investigated the perioperative outcomes of congenital heart disease (CHD) children with recent URI who underwent elective therapeutic catheterisation.

METHODS

We prospectively included children treated for CHD. Before surgery, parents or legal guardians were interviewed to complete a questionnaire on the child's demographics, history of asthma and passive smoking, and URI symptoms. Recorded perioperative respiratory adverse events (PRAEs) included laryngospasm, bronchospasm, breath holding, oxygen desaturation, and severe cough. Information on postoperative dysphoria, fever, copious sputum, and vomiting was obtained by telephone 24 h after surgery.

RESULTS

Of 363 included children, 169 had recently (within 2 weeks) had a URI. The URI did not affect the incidence of laryngospasm, bronchospasm, breath holding, fever, or vomiting. The incidence of desaturation, severe cough, dysphoria, and copious sputum were significantly increased. Independent risk factors for PRAEs in children with a recent URI included age, passive smoking, and presence of rhinorrhoea or moist cough. The lengths of stay in the hospital and intensive care unit were not significantly different between groups.

CONCLUSION

Although recent URI increased the incidence of PRAEs in children undergoing therapeutic cardiac catheterisation, most CHD patients with recent URI can undergo elective therapeutic cardiac catheterisation without serious adverse events or prolonged hospitalisation.

Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events: A Randomized Controlled Trial

BACKGROUND

Limited evidence suggests that children have a lower incidence of perioperative respiratory adverse events when intravenous propofol is used compared with inhalational sevoflurane for the anesthesia induction. Limiting these events can improve recovery time as well as decreasing surgery waitlists and healthcare costs. This single center open-label randomized controlled trial assessed the impact of the anesthesia induction technique on the occurrence of perioperative respiratory adverse events in children at high risk of those events.

METHODS

Children (N = 300; 0 to 8 yr) with at least two clinically relevant risk factors for perioperative respiratory adverse events and deemed suitable for either technique of anesthesia induction were recruited and randomized to either intravenous propofol or inhalational sevoflurane. The primary outcome was the difference in the rate of occurrence of perioperative respiratory adverse events between children receiving intravenous induction and those receiving inhalation induction of anesthesia.

RESULTS

Children receiving intravenous propofol were significantly less likely to experience perioperative respiratory adverse events compared with those who received inhalational sevoflurane after adjusting for age, sex, American Society of Anesthesiologists physical status and weight (perioperative respiratory adverse event: 39/149 [26%] vs. 64/149 [43%], relative risk [RR]: 1.7, 95% CI: 1.2 to 2.3, P = 0.002, respiratory adverse events at induction: 16/149 [11%] vs. 47/149 [32%], RR: 3.06, 95% CI: 1.8 to 5. 2, P < 0.001).

CONCLUSIONS

Where clinically appropriate, anesthesiologists should consider using an intravenous propofol induction technique in children who are at high risk of experiencing perioperative respiratory adverse events.

VISUAL ABSTRACT

An online visual overview is available for this article at http://links.lww.com/ALN/B725.

Deep or awake removal of laryngeal mask airway in children at risk of respiratory adverse events undergoing tonsillectomy-a randomised controlled trial

BACKGROUND

Laryngeal mask airways (LMA) are widely used during tonsillectomies. Contrasting evidence exists regarding the timing of the removal and the risk of perioperative respiratory adverse events. We assessed whether the likelihood of perioperative respiratory adverse events is influenced by the timing of LMA removal in children with at least one risk factor for these events.

METHODS

Participants (n=290, 0-16 yr) were randomised to have their LMA removed either deep (in theatre by anaesthetist at end-tidal sevoflurane >1 minimum alveolar concentration) or awake (in theatre by anaesthetist or in postanaesthesia care unit by anaesthetist or trained nurse). The primary outcome was the occurrence of perioperative respiratory adverse events over the whole emergence and postanaesthesia care unit phases of anaesthesia. The secondary outcome was the occurrence of perioperative respiratory adverse events over the distinct phases of emergence and postanaesthesia care unit.

RESULTS

Data from 283 participants were analysed.

PRIMARY OUTCOME

even though a higher occurrence of adverse events was observed in the awake group, no evidence for a difference was found [45% vs 35%, odds ratio (OR): 1.5, 95% confidence interval (CI): 0.9-2.5, P=0.09]. Secondary outcome: there was no evidence for a difference between the groups during emergence [19 (14%) deep vs 25 (18%) awake, OR: 0.74, 95%CI: 0.39-1.42, P=0.37]. However, in the postanaesthesia care unit, children with an awake rather than deep removal experienced significantly more adverse events [55 (39%) vs 37 (26%); OR: 1.85, 95%CI: 1.12-3.07, P=0.02].

CONCLUSION

We found no evidence for a difference in the timing of the LMA removal on the incidence of respiratory adverse events over the whole emergence and postanaesthesia care unit phases. However, in the postanaesthesia care unit solely, awake removal was associated with significantly more respiratory adverse events than deep removal.

TRIAL REGISTRATION NUMBER

ACTRN12609000387224 (www.anzctr.org.au).

Impact of Viral Respiratory Pathogens on Outcomes After Pediatric Cardiac Surgery

OBJECTIVES

Viral respiratory infection is commonly considered a relative contraindication to elective cardiac surgery. We aimed to determine the frequency and outcomes of symptomatic viral respiratory infection in pediatric cardiac surgical patients.

DESIGN

Retrospective cohort study of children undergoing cardiac surgery. Symptomatic children were tested using a multiplex Polymerase Chain Reaction (respiratory virus polymerase chain reaction) panel capturing nine respiratory viruses. Tests performed between 72 prior to and 48 hours after PICU admission were included. Mortality, length of stay in PICU, and intubation duration were investigated as outcomes.

SETTING

Tertiary PICU providing state-wide pediatric cardiac services.

PATIENTS

Children less than 18 years admitted January 1, 2008 to November 29, 2014 for cardiac surgery.

MEASUREMENTS AND MAIN RESULTS

Respiratory virus polymerase chain reaction was positive in 73 (4.2%) of 1,737 pediatric cardiac surgical admissions, including 13 children with multiple viruses detected. Commonly detected viruses included rhino/enterovirus (48%), adenovirus (32%), parainfluenza virus 3 (10%), and respiratory syncytial virus (3%). Pediatric Index of Mortality 2, Aristotle scores, and cardiopulmonary bypass times were similar between virus positive and negative/untested cohorts. Respiratory virus polymerase chain reaction positive patients had a median 2.0 days greater PICU length of stay (p < 0.001) and longer intubation duration (p < 0.001). Multivariate analysis adjusting for age, Aristotle score, cardiopulmonary bypass duration, and need for preoperative PICU admission confirmed that virus positive patients had significantly greater intubation duration and PICU length of stay (p < 0.001). Virus positive patients were more likely to require PICU admission greater than 4 days (odds ratio, 3.5; 95% CI, 1.9-6.2) and more likely to require intubation greater than 48 hours (odds ratio, 2.5; 95% CI, 1.4-4.7). There was no difference in mortality. No association was found between coinfection and outcomes.

CONCLUSIONS

Pediatric cardiac surgical patients with a respiratory virus detected at PICU admission had prolonged postoperative recovery with increased length of stay and duration of intubation. Our results suggest that postponing cardiac surgery in children with symptomatic viral respiratory infection is appropriate, unless the benefits of early surgery outweigh the risk of prolonged ventilation and PICU stay.

To proceed or not to proceed: ENT surgery in paediatric patients with acute upper respiratory tract infection

Background:

Upper respiratory tract infection is the most common non-preventable cause of surgery cancellation. Consequently, surgeons and anaesthesiologists involved in elective ENT surgical procedures frequently face a dilemma of whether to proceed or to postpone surgery in affected children.

Methods:

A literature review was conducted and a practical assessment algorithm proposed.

Conclusion:

The risk–benefit assessment should take into consideration the impact of postponing the surgery intended to bring relief to the child and the risks of proceeding with general anaesthesia in an inflamed airway. The suggested algorithm for assessment may be a useful tool to support the decision of whether to proceed or to postpone surgery.

Usability of dexmedetomidine for deep sedation in infants and small children with respiratory morbidities

BACKGROUND

Children with respiratory morbidities are at increased risk of developing adverse respiratory events while undergoing deep sedation. Dexmedetomidine possesses sedative properties with minimal respiratory depression. This report aimed to determine the usability of dexmedetomidine in children with significant respiratory morbidities who require deep sedation.

METHODS

Medical records of children with ASA classification III who had at least three characteristics of respiratory morbidities and who received dexmedetomidine sedation for magnetic resonance imaging (MRI) between January 2014 and May 2015 were retrospectively reviewed. Dexmedetomidine was administered as a bolus of 1 μg/kg over 10 min followed by 1 μg/kg/h infusion. If necessary, an additional bolus dose was given and the infusion rate was increased to 2 μg/kg/h. Respiratory morbidities, haemodynamic parameters, total dexmedetomidine dose, adverse cardiorespiratory events and sedation characteristics were analysed.

RESULTS

Nineteen out of 642 children who underwent MRI were eligible for evaluation. Seventeen children (89%) had at least four characteristics of respiratory morbidities. The median [IQR] age was 9 months [3.5-14]. All patients completed MRI scans while breathing spontaneously via the native airway. No episodes of adverse respiratory events or haemodynamic instability were observed. Children who were administered a lower dexmedetomidine dose and had a shorter sedation time were more likely to be younger than 1 year of age.

CONCLUSION

These data demonstrate that dexmedetomidine deep sedation was well-tolerated in children with significant respiratory morbidities. Moreover, children younger than 1 year of age were administered lower dexmedetomidine dose than children older than 1 year of age for the same sedation level.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02555605.

Clinical experience with desflurane for paediatric anaesthesia outside the operating room

BACKGROUND

Desflurane has been used in paediatric patients for several surgical indications. This article analyses the efficacy and safety of desflurane for diagnostic-therapeutic procedures in remote areas far from operating room in a group of selected patients with no known associated respiratory disease.

MATERIAL AND METHODS

A retrospective analysis was performed on 2,072 general anaesthesia procedures stored in a computer database, in which desflurane was used in a Paediatric Pain Unit during the years 2013 and 2014. An analysis was also performed using the patient demographics, type of procedure, anaesthetic technique, type of airway management, patient cooperation, and incidence of anaesthetic complications.

RESULTS

The study included 876 patients, with a mean age of 8.8 years. The main procedures were bone marrow aspirates (23%), lumbar punctures (20%), panendoscopies (15%), and colonoscopies (5%). Induction was intravenous with propofol (26%) or inhalation with sevoflurane in the remaining 74%. Maintenance consisted of remifentanil and desflurane at mean end tidal concentrations of 6.2±2.1%. The airway was managed through a nasal cannula or face mask in spontaneous ventilation. The effectiveness was 98%, and the incidence of side effects was 15%, which included agitation (6%), headache (4%), nausea-vomiting (3%), and laryngospasm (2%).

CONCLUSION

The maintenance with desflurane (at concentrations close to the hypnotic-MAC in spontaneous ventilation) was effective, with a rapid recovery, and with a low incidence of adverse effects.

Anesthesia for ORL surgery in children

ORL procedures are the most common operations in children – an optimal anesthetic management provides an uncomplicated, safe perioperative process with as little discomfort for the child as possible. Children at risk must already be identified preoperatively: the combination of ORL surgery, airway susceptibility and age below 3 years can increase the risk of perioperative respiratory adverse events. Postoperatively, it is important to prevent complications such as pain and PONV by dedicated prevention and treatment strategies, as well as to recognize and treat respiratory or circulatory complications competently. Interdisciplinary guidelines and agreements as well as the overall competence of the team have the potential to improve patient safety and outcome in children.

A randomized, single-blinded, prospective study that compares complications between cuffed and uncuffed nasal endotracheal tubes of different sizes and brands in pediatric patients

STUDY OBJECTIVE

To compare any association between the problematic distal placement of cuffed and uncuffed nasal endotracheal tubes (NETTs) of different sizes and brands in pediatric patients.

DESIGN

Randomized, single-blinded, prospective study.

SETTING

Operating room at The Children's Hospital.

PATIENTS

Pediatric patients (aged 2-18 years) scheduled for dental surgery under general anesthesia whose American Society of Anesthesiologists physical status is not greater than 2.

INTERVENTION

Patients were randomly assigned to preformed cuffed (1) RAE (Ring-Adair-Elwyn) endotracheal tube by Mallinckrodt or (2) nasal AGT NETT by Rüsch.

MEASUREMENTS

The distance between the tube's distal end and the carina was measured using a fiber optic bronchoscope. Problematic placements were defined where the tip of the tubes was within 0.5 cm of carina.

MAIN RESULTS

The odds of a problematic placement was 7 times higher (95% confidence interval of odds ratio, 2.06, 23.4) in patients managed with cuffed tubes than those with uncuffed tubes (P = .002). The distance between the tip of cuffed NETT tubes and carina was significantly less than with uncuffed tubes.

CONCLUSIONS

The chances of possible complications were significantly higher with cuffed NETT. The NETT should be kept at least 0.5 cm above carina to avoid possible complications.

Supraglottic airway devices vs tracheal intubation in children: a quantitative meta-analysis of respiratory complications

BACKGROUND

Rate of perioperative respiratory complications between tracheal intubation (TI) and laryngeal mask airway remains unclear during pediatric anesthesia.

OBJECTIVES

The aim of the present meta-analysis was to compare the perioperative respiratory complications between laryngeal mask airway and TI.

METHODS

A meta-analysis of available controlled studies comparing laryngeal mask airway to TI was conducted. Studies including patients with airway infection were excluded. Data from each trial were combined to calculate the pooled odds ratios (OR) or mean difference (MD) and 95% confidence intervals.

RESULTS

The meta-analysis was performed on 19 studies. In 12 studies, patients were given muscle relaxation, and in 16 studies, ventilation was controlled. During recovery from anesthesia, the incidence of desaturation (OR = 0.34 [0.19-0.62]), laryngospasm (OR = 0.34 [0.2-0.6]), cough (OR = 0.18 [0.11-0.27]), and breath holding (0.19 [0.05-0.68]) was lower when laryngeal mask airway was used to secure the airway. Postoperative incidences of sore throat (OR = 0.87 [0.53-1.44]), bronchospasm (OR = 0.56 [0.25-1.25]), aspiration (1.33 [0.46-3.91]) and blood staining on the device (OR = 0.62 [0.21-1.82]) did not differ between laryngeal mask airway and TI. Results were homogenous across the studies, with the exceptions of blood staining on the device.

CONCLUSIONS

This meta-analysis found that the use of laryngeal mask airway in pediatric anesthesia results in a decrease in a number of common postanesthetic complications. It is therefore a valuable device for the management of the pediatric airway.

Pediatric ambulatory anesthesia

Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed.

Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study)

BACKGROUND

Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case.

METHODS

We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs.

RESULTS

GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n=1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p<0.05).

CONCLUSIONS

AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients.