Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study

Ungern‐Sternberg, Britta S. von; Boda, Krisztina; Chambers, Neil; Rebmann, Claudia; Johnson, Chris; Sly, Peter D.; Habre, Walid

doi:10.1016/s0140-6736(10)61193-2

Cited by 489 publications

(556 citation statements)

References 32 publications

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“…Total IgE, a nonspecific marker, and IgE antibodies to Gx2 were the only parameters found to be associated with an increased incidence of adverse respiratory events. Although airway sensitivity is a strong predictor for adverse respiratory events [2,6], the association of serum markers with a higher risk for airway inflammation has not been assessed before. We have previously shown that eosinophilic cationic protein (in bronchoalveolar lavage fluid), released by activated eosinophils and tryptase, and which reflects mast cell degranulation, correlated with elevated airway pressures and a higher risk for peri-operative bronchospasm in anaesthetised children [6].…”

Section: Discussionmentioning

confidence: 99%

“…We have previously identified a range of pre-operative factors that were associated with an increased risk for adverse respiratory events [2]. Among these factors, clinical features that are surrogate indicators of inflammation of the airway, such as a personal or family history of atopy, asthma and respiratory symptoms, were found to be highly correlated with the occurrence of adverse respiratory events.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of our study was to assess whether immunological markers, including eosinophil count and total and specific IgE values, would improve the prediction of adverse respiratory events in children presenting for elective surgery who are at particularly high risk due to the presence of two or more risk factors [2].…”

Section: Introductionmentioning

confidence: 99%

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Peri-operative adverse respiratory events in children

et al. 2014

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SummaryThree quarters of all critical incidents and a third of all peri-operative cardiac arrests in paediatric anaesthesia are caused by adverse respiratory events. We screened for risk factors from children's and their families' histories, and assessed the usefulness of common markers of allergic sensitisation of the airway as surrogates for airway inflammation and increased risk for adverse respiratory events. One hundred children aged up to 16 years with two or more risk factors undergoing elective surgery were included in the study. Eosinophil counts, IgE level, specific IgE for D. pteronyssinus, cat epithelia and Gx2 (grass pollen) were measured for each child and adverse respiratory events (bronchospasm, laryngospasm, oxygen desaturation < 95%, severe persistent coughing, airway obstruction and postoperative stridor) were recorded. Twenty-one patients had an adverse respiratory event but allergic markers were poor predictors. Binary logistic regression showed a lack of predictive value of the eosinophil range and adverse respiratory events (p = 0.249). Receiver operating characteristic (ROC) curves for the presence of adverse respiratory events vs level of specific IgE antibody (to Gx2 (AUC 0.614), cat epithelia (0.564) and D. pteronyssinus (0.520)) demonstrated poor predictive values. However, the presence of risk factors was strongly associated with adverse respiratory events (p < 0.001) and a ROC-curve analysis indicated a fair capacity to predict adverse respiratory events (AUC 0.788). There was a significant difference (p = 0.001) between the presence of adverse respiratory events in patients with more than four (p = 0.006), compared with less than four (p = 0.001), risk factors. We conclude that while risk factors taken from the child's (or family) history proved good predictors of adverse respiratory events, immunological markers of allergic sensitisation demonstrated low predictive values. Pre-operative identification of children at high risk for an adverse respiratory event should rely on clinical, rather than immunological, assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Peri-operative adverse respiratory events in children

et al. 2014

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“…It is worth remembering that respiratory tract infections result in airway hyperactivity, persisting for up to 6 weeks. Anaesthesia delivered during infections or within 2 post-infection weeks increases the risk of respiratory complications, so is passive smoking [6]. Rhinorrhoea, allergic and chronic rhinitis without general symptoms are not contraindications to anaesthesia for elective surgery [8].…”

Section: Medical Historymentioning

confidence: 99%

“…up to 28%, it mainly pertains to severely ill patients (ASA III−V), particularly those after emergency procedures. According to Coté [5], the factors determining the safety of paediatric patients during procedural sedation and analgesia (PSA) primarily include the professional skills of healthcare providers performing the procedures and, to a lesser extent, the drugs used, except in cases of overdosing and drug interactions, which was also confirmed by Ungen von Sternberg and co-workers [6].…”

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confidence: 94%