The child with a cold

 

Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study - PubMed (nih.gov)

 

List:

·        Summary

·        Disease

·        Considerations

·        Anaesthesia

 

Summary:

Problems with proceeding

·          Risk of airway complications

o   20-30% benign

o   0.5-1% serious

Problems with cancellation

·          Most airway complications are benign and easily treatable

·          Hyperreactivity lasts 6 weeks, just in time for the next cold

·          Cancellation is hard on the child and family

Upshot

·          Green light: simple URTI, anything if resolved >2/52 ago

·          Red flags: high fever, secretions ++, crackles, active asthma

 

Airway complications:

Causes

·          Hyperreactive airways

·          Impaired mechanics

·          Impaired gas exchange

Risk factors

Patient:

·          Asthma

·          Symptomatic URTI

·          Resolved <2/52

Anaesthesia:

·          Inhalational induction

·          Inhalational maintenance

·          Intubation

·          Inexperience

Intra-op problems

Especially induction and emergence

·          Breath holding

·          Desaturation

·          Coughing

·          Larnyogspasm

·          Bronchospasm

·          Airway obstruction

Post-op problems

·          Prolonged intubation

·          Re-intubation

·          Oxygen requirement

·          Post-extubation stridor

·          Hospital admission

·          Pneumonia

 

Assessment:

 

Patient:

HOPC

General:

·          Activity level

·          Oral intake

·          Wet nappies

URTI:

·          Cough

·          Snoring

·          Secretions

Background

PMHx:

·          Prematurity

·          General health

·          Respiratory disease / “bronchiolitis”

·          Atopy

FHx:

·          Smoking

·          Atopy

Examination

·          General appearance: WOB, lethargy

·          Vital signs: high fever, SpO2

·          Airway: difficult-looking?

·          Breathing: wheeze, crackles

 

Circumstances:

Family

·          Previous did-not-attends

·          Previous cancellations

·          Travel time

Surgery

·          Airway surgery

·          Urgency

Hospital

·          Paediatric caseload

·          Inpatient beds

·          Other anaesthetists present

·          Assistant’s training

·          PACU nurses’ training

 

 

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