Anesthetic concerns for pediatric patients in the era of COVID‐19

Abstract

After a novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), was reported in China in December 2019, the disease quickly reached pandemic level. On January 30, 2020, the World Health Organization (WHO) declared that the SARS‐CoV‐2 outbreak constituted a Public Health Emergency of International Concern. The caseload has increased exponentially, with WHO reporting 182 000 global cases by March 17, 2020, and over 2.6 million by 23 April. The clinical situation is complex, with children presenting different clinical features compared to adults. Several articles with recommendations on the anesthetic management of adult patients with COVID‐19 have been published, but no specific recommendations for pediatric anesthesiologists have been made yet. This article addresses specific concerns for the anesthetic management of the pediatric population with COVID‐19.

Unique challenges in pediatric anesthesia created by COVID-19

“…A tight seal with the facemask and avoiding high gas flows may be beneficial to minimize any exposure to personnel in the room. For an intravenous induction of anesthesia, a rapid sequence technique can help avoid bag-mask ventilation and coughing [26]. Techniques such as video laryngoscopy have been recommended to place the intubator's face further away from the patient, however this must be balanced with the comfort level of the anesthesiologist with different laryngoscopy techniques in children and the relative speed and first-pass success rate of securing the airway.…”

Anesthetic Management in an Infant with Dandy–Walker Syndrome Presenting with Acyanotic Heart Disease and Hydrocephalous Post-COVID-19 Recovery: A Rare Experience

“…Perioperative concerns for surgery in such cases are false-negative RT-PCR in children, low yield of viral ribonucleic acid (RNA) from nasopharyngeal samples, nonspecific symptomatology, risk of perioperative viral aerosolization, postviral reactive airway with critical respiratory events during extubation, unexpected postop ventilation, and myocarditis (38-50%). [5][6][7] Data on clinical outcomes in pediatric patients with COVID-19 undergoing emergency surgery is sketchy and mostly extrapolated from adult studies. [5][6][7] This was a multidisciplinary effort involving cardiac-and neuroanesthesiologists and cardiac and neurosurgeons with perioperative intensive care management for successful outcome.…”

“…[5][6][7] Data on clinical outcomes in pediatric patients with COVID-19 undergoing emergency surgery is sketchy and mostly extrapolated from adult studies. [5][6][7] This was a multidisciplinary effort involving cardiac-and neuroanesthesiologists and cardiac and neurosurgeons with perioperative intensive care management for successful outcome.…”

A survey of the global impact of COVID‐19 on the practice of pediatric anesthesia: A study from the pediatric anesthesia COVID‐19 Collaborative Group

“…Much of the current pediatric anesthesia COVID-19 literature is focused on how to care for children in the perioperative setting, including methods for the resumption of elective outpatient surgery through preoperative testing. [8][9][10] COVID-19 directly impacted anesthesiologists because their own health is at risk when caring for infected patients. In addition, the pandemic increased emotional stress and created the possibility of adverse financial impact.…”

“…Anesthesiology, including pediatric anesthesiology, has been greatly impacted by COVID‐19, not just in the delivery of care to patients but for the individual anesthesiology providers as well. Much of the current pediatric anesthesia COVID‐19 literature is focused on how to care for children in the perioperative setting, including methods for the resumption of elective outpatient surgery through preoperative testing 8‐10 …”