Abstract
Purpose
Upper respiratory infections (URI) presage perioperative respiratory complications, but thresholds to cancel surgery vary widely. We hypothesized that autonomically-mediated complications seen during emergence from anesthesia would be predicted by capnometry and reduced with preoperative bronchodilator administration.
Methods
Afebrile outpatient tertiary-care children (age two months to 18 yr,n = 109) without lung disease or findings, having non-cavitary, non-airway surgery for under three hours, were randomized to bronchodilator premedication vs placebo and had preoperative capnometry. After halothane via mask, laryngeal mask airway, or endotracheal tube, and regional anesthesia as appropriate, patients recovered breathing room air while cough, wheeze, stridor, laryngospasm, and cumulative desaturations were recorded for 15 min.
Results
In this specific population, there was no association between adverse events and either URl within six weeks (n = 76) or URl within seven days (n = 21). Neither albuterol nor ipratropium premedication decreased adverse events. Endotracheal intubation was associated with increased emergence desaturations and placebo nebulized saline increased emergence coughing. Neither anesthesiologists nor preoperative capnometry predicted adverse events.
Conclusions
Adverse events were neither predicted nor prevented. In afebrile outpatient ASA l and ll children with no lung disease or findings, having non-cavitary, non-airway surgery for under three hours, there was no association between either recent URl or active URl and desaturation, wheeze, cough, stridor, or laryngospasm causing desaturation (allP > 0.05). In this highly selected population of afebrile patients, the results suggest that anesthesiologists may proceed with surgery using specific criteria in the presence of a URl.
Résumé
Objectif
Les infections des voies respiratoires supérieures (lRS) présagent des compiications respiratoires périopératoires, mais les valeurs seuils qui pourraient faire annuler l’opération chirurgicale varient beaucoup. Notre hypothèse était que ies complications d’origine autonome pendant le réveil postanesthésique, pourraient être prédites par ia capnométrie et réduites par l’administration préopéra-toire de bronchodilatateur.
Méthode
Des enfants afébriies admis à l’unité externe de soins tertiaires, (deux mois à 18 ans, n = 109), sans infection pulmonaire connue ou constatée, devant subir une opération de moins de trois heures ne touchant ni une cavité ni les voies aériennes, ont été répartis de façon aléatoire pour recevoir une prémédication bronchodilatatrice ou un placebo, et ont été soumis à une capnométrie préopératoire. Après l’administration d’halothane par masque, la mise en place d’un masque laryngé, ou d’un tube endotrachéal, et l’anesthésie régionale quand c’était indiqué, les patients ont respiré spontanément l’air ambiant. Toux, respiration siffiante, stridor, laryngospasme et désaturation cumulative ont été enregistrés pendant 15 min.
Résultats
Dans cette popuiation spécifique, aucun lien n’a été noté entre ies événements indésirabies et, soit une lRS dans les six dernières semaines (n = 76) ou les sept derniers jours (n = 21). La prémédication avec albutérol ou ipratropium n’a pas réduit les événements indésirables. L’intubation endotrachéaie a été associée à une désaturation accrue au réveil et la solution saline en aérosol a augmenté la
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This study was carried out at Johns Hopkins Hospital, Baltimore, MD and Children’s Hospital and Regional Medical Centre, Seattle, WA, USA.
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Elwood, T., Morris, W., Martin, L.D. et al. Bronchodilator premedication does not decrease respiratory adverse events in pediatric general anesthesia. Can J Anaesth 50, 277–284 (2003). https://doi.org/10.1007/BF03017798
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DOI: https://doi.org/10.1007/BF03017798