Unique challenges in pediatric anesthesia created by COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) has affected anesthetic care worldwide, including the provision of anesthesia for pediatric patients. Hospitals have balanced the risks associated with the potential surges of resource-intensive COVID-19 patients against the probable morbidity of delaying elective surgical procedures. These decisions are complicated by the unclear influence that COVID-19 has on the perioperative risk for disease-positive pediatric patients. We conducted a comprehensive literature search on MEDLINE for publications involving pediatric patients with COVID-19 who underwent general anesthesia. A total of eight publications met inclusion criteria, and together described 20 patients. Nine patients had documented preoperative COVID-19 symptoms and one perioperative death was reported. Overall, further studies are needed to increase patient numbers and properly assess the perioperative risk. As we continue to provide care without clear guiding data, we present a discussion of modified anesthetic techniques for pediatric patients with suspected or confirmed COVID-19.

Complications associated with paediatric airway management during the COVID‐19 pandemic: an international, multicentre, observational study

“…A review of children with COVID‐19 who had a general anaesthetic reported one peri‐operative death in nine symptomatic cases [ 3 ]. Studies have reported anaesthesia‐related complications in adults with COVID‐19 [ 3 , 4 , 5 ].…”

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.…”

“…Patients with acyanotic heart disease with left-to-right-shunt and severe PAH often present with congestive heart failure and failure to thrive with recurrent chest infection due to increased pulmonary flow. 6 So, ligation of PDA and PAB were performed as a palliation to limit the pulmonary flow. 9 The rationale behind performing cardiac corrective surgery before shunt placement is open cerebral fontanelles at this age, which compensates for raised ICP.…”

Specialised training in paediatric anaesthesia

“…Anaesthesiologists need to be aware of children specific problems and their management e.g., avoiding nasal premedication since it can cause aerosolisation. [ 11 ] In addition, anaesthesia management by a paediatric anaesthesiologist will enable safe and quick performance of routine tasks like intubation as well as complex tasks like placement of invasive lines and nerve blocks. A generalist is more likely to struggle and take extra time for performance of these practical tasks thereby increasing the possibility of aerosol generation.…”