Upper Respiratory Tract Infection
Background
-
Upper respiratory tract infection (URTI) definition is two or more of the following symptoms: rhinorrhoea, sore or scratchy throat, sneezing, nasal congestion, malaise, cough, or fever > 38°C
-
children under the age of 4 have on average up to 8 URTI per year
-
Between 25%-45% of children presenting for elective surgery will have a history of a recent URTI
-
URTI is the most common cause of surgery cancellation in children
Considerations
-
↑ Risk of perioperative respiratory adverse events (e.g. laryngospasm, bronchospasm, desaturations, breath holding) up to 2 weeks after a URTI
-
Risk factors that ↑ this risk further: age <2, prematurity, passive smoking, respiratory comorbidities, airway surgery, and use of ETT
-
Risk and benefit analysis of proceeding with surgery by considering the severity of the URTI and the urgency of the surgery
Management
-
Determine whether or not to proceed with surgery
-
Mild URTI (clear runny nose, dry cough):
-
Proceed with surgery but practice good perioperative pulmonary care
-
-
Moderate URTI (green runny nose, mild moist cough):
-
Need to consider risk/benefit ratio for the patient
-
Factors in favour of proceeding: team experience, institutional setting, previous cancellations and logistics, non-invasive airway management, extended monitoring possible
-
Factors in favour to cancel: parental concerns, age <1 year and prematurity, respiratory comorbidity, certain viral illnesses such as RSV, airway surgery, ETT required
-
-
Severe URTI (green runny nose, severe moist cough, wheezing, fever, lethargy): post-pone and re-evaluate in 2 weeks
-
-
Good preoperative pulmonary care:
-
Experienced paediatric anesthesia team
-
Less invasive airway device (e.g. LMA) preferred
-
Consider pre-treatment with inhaled salbutamol
-
IV induction is preferred
-
Avoid desflurane
-
TIVA or propofol bolus prior to airway removal
-
IV lidocaine may be helpful to reduce the laryngospam reflex
-
References
-
An update on the perioperative management of children with upper respiratory tract infections. Current Opinion in Anaesthesiology: June 2017 - Volume 30 - Issue 3 - p 362-367.