Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 48

Respiratory complications in the pediatric population are the most frequently observed adverse event and are typically mild in nature, responding well to supplemental oxygen or head repositioning. The most common complication in children is respiratory depression and oxygen desaturation and ranges from less than 1–11% of subjects, depending on the study [24]. More frequent respiratory depression and desaturation are observed with combinations of IV medications, particularly combinations of narcotics and benzodiazepines or narcotics and propofol [24]. In a recently published report from the Pediatric Sedation Research Consortium on the use of propofol sedation/anesthesia for outpatient procedures, the number of respiratory complications outnumbered other complications significantly and included the following specific events in decreasing order of frequency: desaturation less than 90% for greater than 30 seconds; airway obstruction; cough; excessive secretions; apnea; and laryngospasm [23]. The authors of the study identified 1 in 65 anesthetics as being complicated by adverse respiratory events, and 1 in 70 anesthetics required airway interventions, including placement of an oral or nasal airway, positive pressure ventilation, or endotracheal intubation [23]. A study by Kakavouli et al. reports an overall incidence rate of intraoperative respiratory complications of 1.9% with laryngospasm and bronchospasm identified as the most common adverse events [22]. Two separate studies on perioperative cardiac arrest in children list respiratory events [7] and airway‐related causes [2] as the main causes of cardiac arrest attributable to anesthesia. Cravero et al. report two cases of cardiac arrest in children, one of which occurred secondary to laryngospasm and profound hypoxia, and the second that resulted after an apneic episode and bradycardia [23]. These cases underscore the fact that cardiac arrest in children is frequently preceded by respiratory arrest, whereas adults more frequently experience cardiac arrest secondary to MI or arrhythmia.