Risk factors for perioperative adverse respiratory events in children withupper respiratory tract infections

Background: Anesthesia for the child who presents for surgery with an upper respiratory infection (URI) presents a challenge for the anesthesiologist. The current prospective study was designed to determine the incidence of a nd risk factors for adverse respiratory events in children with URIs underg oing elective surgical procedures. Methods: The study population included 1,078 children aged I month to IS yr who presented for an elective surgical procedure. Parents were given a sho rt questionnaire detailing their child's demographics, medical history, and presence of any symptoms of a URI. Data regarding the incidence and severi ty of perioperative respiratory events were collected prospectively. Advers e respiratory events (any episode of laryngospasm, bronchospasm, breath hol ding > 15 s, oxygen saturation < 90%, or severe cough) were recorded. In ad dition, parents were contacted I and 7 days after surgery to determine the child's postoperative course. Results: There were no differences between children with active URIs, recen t URIs (within 4 weeks), and asymptomatic children with respect to the inci dences of laryngospasm and bronchospasm. However, children with active and recent URIs had significantly more episodes of breath holding, major desatu ration (oxygen saturation < 90%) events, and a greater incidence of overall adverse respiratory events than children with no URIs. Independent risk fa ctors for adverse respiratory events in children with active URIs included use of an endotracheal tube (<less than> 5 yr of age), history of prematuri ty, history of reactive airway disease, paternal smoking, surgery involving the airway, the presence of copious secretions, and nasal congestion. Alth ough children with URIs had a greater incidence of adverse respiratory even ts, none were associated with any longterm adverse sequelae. Conclusions: The current study identified several risk factors for perioper ative adverse respiratory events in children with URIs. Although children w ith acute and recent URIs are at greater risk for respiratory complications , these results suggest that most of these children can undergo elective pr ocedures without significant increase in adverse anesthetic outcomes.