SNOTTY CHILDREN AND ANAESTHESIA

This is a challenge every day in ENT surgery anaesthesia: Sorting out which snotty ENT children can go through with surgery, and which ones to cancel. The trend has moved from scrapping all snotty children, to making an individual assessment and letting more of them through.

This article from Anesthesia & Analgesia gives a great overview of the problem and it’s challenges as well as a practical guide to the management of these children. It’s pretty much how we usually do it in our anaesthetic practice, but the article gives some good pointers, and a good background for our management practice. Read!

Anesthesia for the Child with an Upper Respiratory Tract Infection: Still a Dilemma? – Anesthesia & Analgesia, 2005

Main points:
Typically, children experience 6-8 upper respiratory tract infections (URI’s) per year. Children with URI or URI within the last 4 weeks were 2-7 times more likely to experience respiratory-related complications and 11 times more likely if their trachea were intubated.

These complications included desaturation (<90%), bronchospasm and laryngospasm. The vast majority of these complications were easily amended, but any respiratory-related complication in children can quickly go from bad to ugly, and are to be taken seriously - and best avoided. Risk factors include:

    Nasal congestion
    Parental smoking
    Surgery of Airway
    History of Asthma
    History of prematurity

Anaesthesia risks:

    ETT>LMA>Face mask
    Thio>Sevo>Propofol

The good, bad and the difficult:
Not so snotty children with mild, uncomplicated URI, clear secretions and no instrumentation of the airway – safe.
Snotty children with mucopurulent secretions, productive cough, fever >38°C, lethargy, or signs of pulmonary involvement – should postpone surgery for a minimum of 4 weeks.
Children in between: read the article and make an individual decision.

Update: Here is a recent case report and review of the current state of snotty children and anaesthesia from Anesthesiology 2012. Don’t be fooled by the article title – there’s a very good overview for paediatric anaesthesia in there as well: Case Scenario: Perianesthetic Management of Laryngospasm in Children. I will be incorporating this article into the post here – soonish.

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