Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in pediatric anesthesia—Part 1 patient and surgical factors

Hii, Justin; Templeton, T. Wesley; Sommerfield, David; Sommerfield, Aine; Matava, Clyde; Ungern‐Sternberg, Britta S. von

doi:10.1111/pan.14377

Cited by 21 publications

(18 citation statements)

References 43 publications

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“…Postoperative respiratory complications in children who are symptomatic with upper respiratory infections (URI) other than SARS-CoV-2 appear to be more common, ranging from 24-30% [19] , [20] , [21] , [22] . As COVID-19 is now an endemic problem, moving forward it may be prudent to develop policies where symptomatic patients are treated the same as symptomatic patients with other URIs.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study

Reiter¹,

Ingram²,

Raval³

et al. 2023

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 99%

Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study

Reiter¹,

Ingram²,

Raval³

et al. 2023

Journal of Pediatric Surgery

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“…Of note, recent reports have suggested that the long-held wisdom that children with OSA have increased sensitivity to the respiratory depressive effect of opioids may be inaccurate. 60,61…”

Section: Perioperative Opioidsmentioning

confidence: 99%

“…Pulse oximetry monitoring and potentially other measures of ventilation should be employed in these patients or other higher risk situations. Of note, recent reports have suggested that the long‐held wisdom that children with OSA have increased sensitivity to the respiratory depressive effect of opioids may be inaccurate 60,61 …”

Section: Main Articlementioning

confidence: 99%

Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia‐related risk and treatment options

Templeton

Sommerfield

Hii

et al. 2021

Pediatric Anesthesia

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Perioperative respiratory adverse events are the most common cause of critical events in children undergoing anesthesia and surgery. While many risk factors remain unmodifiable, there are numerous anesthetic management decisions which can impact the incidence and impact of these events, especially in at-risk children. Ongoing research continues to improve our understanding of both the influence of risk factors and the effect of specific interventions. This review discusses anesthesia risk factors and outlines strategies to reduce the rate and impact of perioperative respiratory adverse events with a chronologic based inquiry into anesthetic management decisions through the perioperative period from premedication to postoperative disposition.

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“…26 Previous studies have demonstrated pediatric-specific risk factors for adverse respiratory events under general anesthesia, including younger age, a history of reactive airway disease, prematurity, the presence of an upper respiratory tract infection, obesity, obstructive sleep apnea, and tobacco smoke exposure in the home. 27 These factors help risk stratify patients presenting for anesthesia, 28 and may impact anesthetic choices. Understanding the effect of the air quality index on the incidence of adverse respiratory events under general anesthesia could be an important factor to help further assess these patients.…”

Section: Editor's Perspectivementioning

confidence: 99%

Wildfire Smoke Exposure Is Associated with Adverse Respiratory Events under General Anesthesia in At-risk Pediatric Patients

et al. 2022

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Background Increasing wildfire activity worldwide has led to exposure to poor air quality and numerous detrimental health impacts. This study hypothesized an association between exposure to poor air quality from wildfire smoke and adverse respiratory events under general anesthesia in pediatric patients. Methods This was a single-center retrospective double-cohort study examining two significant wildfire events in Northern California. Pediatric patients presenting for elective surgery during periods of unhealthy air quality were compared to those during periods of healthy air quality. The primary exposure, unhealthy air, was determined using local air quality sensors. The primary outcome was the occurrence of an adverse respiratory event under anesthesia. Secondary analysis included association with other known risk factors for adverse respiratory events. Results 625 patients were included in the analysis. The overall risk of a respiratory complication was 42.4% (265/625). In children without history of reactive airway disease, the risk of adverse respiratory events did not change during unhealthy air periods (102/253, 40.3%) as compared with healthy air periods (95/226, 42.0%) (relative risk 0.96 (0.77 to 1.19), p = 0.703). In children with history of reactive airway disease, the risk of adverse respiratory events increased from 36.8% (25/68) during healthy air periods to 55.1% (43/78) during periods with unhealthy air (1.50 (1.04 to 2.17), p = 0.032). The effect of air quality on adverse respiratory events was significantly modified by reactive airways disease status (1.56 (1.02 to 2.40), p = 0.041). Conclusions Pediatric patients with underlying risk factors for respiratory complications under general anesthesia had a greater incidence of adverse respiratory events during periods of unhealthy air quality caused by wildfire smoke. In this vulnerable patient population, postponing elective anesthetics should be considered when air quality is poor.

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Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in pediatric anesthesia—Part 1 patient and surgical factors

Cited by 21 publications

References 43 publications

Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study

Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study

Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia‐related risk and treatment options

Wildfire Smoke Exposure Is Associated with Adverse Respiratory Events under General Anesthesia in At-risk Pediatric Patients

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