Читать книгу Practical Pediatric Gastrointestinal Endoscopy - Группа авторов - Страница 39

The presence of URI is ubiquitous in pediatrics. The decision to cancel a procedure due to an upper respiratory infection can have impacts on patient care, as well as logistical problems for healthcare providers and parents. There are numerous studies suggesting that when anesthesia is administered to a patient with an active or recent URI, there is an increased frequency of airway events such as coughing or laryngo/bronchospasm.

In 2012 the PRSC evaluated this question. A total of 83 491 sedations were included; 70 830 without URI were compared to 13 319 patients with either recent or active URI, classified as having either thin or thick colored secretions. Data were examined for airway‐related adverse events.

Occurrence of adverse events increased progressively from 6.3% for those with no URI, 9.3% for recent URI, 14.6% for URI with thin secretions, to 22.2% for those with URI and thick secretions (p < 0.001). The most common events were airway obstruction, oxygen desaturation, snoring, cough that interfered with the procedure, secretions requiring suctioning, stridor, or wheezing. The need for airway interventions followed an identical pattern, increasing from no URI through URI with thick secretions. The most common interventions were providing BVM, suction, or repositioning. There were no emergent airway interventions, unplanned admissions, or administrations of CPR.

The data suggest that in addition to a recent or active URI, the nature of the secretions is significant in assessing risk, with thick secretions carrying the highest risk. While the findings revealed a statistically significant difference, the nature of the events and consequences may not be clinically significant. Events such as laryngospasm, aspiration, emergent intubation, unplanned admission, and emergent call for anesthesia all remained <1% regardless of URI status. While there is a higher risk for adverse events in children with recent or active URI with thick secretions, these must be balanced against the acuity of the patient’s condition and the urgency of procedure.