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

von Ungern-Sternberg, Britta S., Boda, Krisztina, Chambers, Neil A., Rebmann, Claudia, Johnson, Chris, Sly, Peter D. and Habre, Walid (2010) Risk assessment for respiratory complications in paediatric anaesthesia: A prospective cohort study. The Lancet, 376 9743: 773-783. doi:10.1016/S0140-6736(10)61193-2

Author von Ungern-Sternberg, Britta S.
Boda, Krisztina
Chambers, Neil A.
Rebmann, Claudia
Johnson, Chris
Sly, Peter D.
Habre, Walid
Title Risk assessment for respiratory complications in paediatric anaesthesia: A prospective cohort study
Journal name The Lancet   Check publisher's open access policy
ISSN 0140-6736
Publication date 2010-09
Sub-type Article (original research)
DOI 10.1016/S0140-6736(10)61193-2
Volume 376
Issue 9743
Start page 773
End page 783
Total pages 11
Place of publication London, England, U.K.
Publisher The Lancet Publishing Group
Collection year 2011
Language eng
Formatted abstract
Background: Perioperative respiratory adverse events in children are one of the major causes of morbidity and mortality during paediatric anaesthesia. We aimed to identify associations between family history, anaesthesia management, and occurrence of perioperative respiratory adverse events.

Methods: We prospectively included all children who had general anaesthesia for surgical or medical interventions, elective or urgent procedures at Princess Margaret Hospital for Children, Perth, Australia, from Feb 1, 2007, to Jan 31, 2008. On the day of surgery, anaesthetists in charge of paediatric patients completed an adapted version of the International Study Group for Asthma and Allergies in Childhood questionnaire. We collected data on family medical history of asthma, atopy, allergy, upper respiratory tract infection, and passive smoking. Anaesthesia management and all perioperative respiratory adverse events were recorded.

Findings: 9297 questionnaires were available for analysis. A positive respiratory history (nocturnal dry cough, wheezing during exercise, wheezing more than three times in the past 12 months, or a history of present or past eczema) was associated with an increased risk for bronchospasm (relative risk [RR] 8·46, 95% CI 6·18–11·59; p<0·0001), laryngospasm (4·13, 3·37–5·08; p<0·0001), and perioperative cough, desaturation, or airway obstruction (3·05, 2·76–3·37; p<0·0001). Upper respiratory tract infection was associated with an increased risk for perioperative respiratory adverse events only when symptoms were present (RR 2·05, 95% CI 1·82–2·31; p<0·0001) or less than 2 weeks before the procedure (2·34, 2·07–2·66; p<0·0001), whereas symptoms of upper respiratory tract infection 2–4 weeks before the procedure significantly lowered the incidence of perioperative respiratory adverse events (0·66, 0·53–0·81; p<0·0001). A history of at least two family members having asthma, atopy, or smoking increased the risk for perioperative respiratory adverse events (all p<0·0001). Risk was lower with intravenous induction compared with inhalational induction (all p<0·0001), inhalational compared with intravenous maintenance of anaesthesia (all p<0·0001), airway management by a specialist paediatric anaesthetist compared with a registrar (all p<0·0001), and use of face mask compared with tracheal intubation (all p<0·0001).

Interpretation: Children at high risk for perioperative respiratory adverse events could be systematically identified at the preanaesthetic assessment and thus can benefit from a specifically targeted anaesthesia management.

Funding: Department of Anaesthesia, Princess Margaret Hospital for Children, Swiss Foundation for Grants in Biology and Medicine, and the Voluntary Academic Society Basel.

Copyright © 2011 Elsevier B.V.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
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Created: Wed, 17 Nov 2010, 11:57:05 EST