Short Judith A, van der Walt Johan H, Zoanetti David C
Department of Paediatric Anaesthesia, Leeds General Infirmary, West Yorkshire, UK.
Paediatr Anaesth. 2006 May;16(5):514-22. doi: 10.1111/j.1460-9592.2006.01897.x.
There is no direct evidence of any major interaction between immunization and commonly used anesthetic agents and techniques in children, but it is possible that immunosuppression caused by anesthesia and surgery may lead to decreased vaccine effectiveness or an increased risk of complications. In addition, diagnostic difficulty may arise if a recently immunized child suffers from postoperative pyrexia or malaise.
The aim of this study was to ascertain anesthetists' attitudes and practices regarding anesthesia and immunization.
We conducted an international survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) and the Society for Paediatric Anaesthesia of New Zealand and Australia (SPANZA).
Two hundred and ninety-six (52.1%) APAGBI and 86 (49.4%) SPANZA responses were analyzed. There was no consensus of approach to this theoretical risk among respondents. In total, 60% of respondents would anesthetize a child for elective surgery within 1 week of receiving a live attenuated vaccine, but 40% would not. Few hospitals have formal policies on this issue and government guidance is based on a lack of evidence for adverse events rather than positive evidence of safety.
There is a theoretical risk associated with anesthesia and surgery in recently immunized children. An international postal survey failed to find a consensus to this risk among pediatric anesthetists. From a risk management perspective, a review of the available evidence suggests that it would be prudent to adopt a cautious approach where the timing of elective surgery is discretionary. We therefore recommend that elective surgery and anesthesia should be postponed for 1 week after inactive vaccination and 3 weeks after live attenuated vaccination in children.
目前尚无直接证据表明儿童免疫接种与常用麻醉药物和技术之间存在任何重大相互作用，但麻醉和手术引起的免疫抑制可能会导致疫苗效力降低或并发症风险增加。此外，如果近期接种过疫苗的儿童术后出现发热或不适，可能会出现诊断困难。
本研究的目的是确定麻醉医生对麻醉和免疫接种的态度及做法。
我们对英国和爱尔兰儿科麻醉师协会（APAGBI）以及新西兰和澳大利亚儿科麻醉学会（SPANZA）的成员进行了一项国际调查。
分析了296份（52.1%）APAGBI的回复和86份（49.4%）SPANZA的回复。受访者对于这种理论风险没有一致的处理方法。总体而言，60%的受访者会在儿童接种减毒活疫苗1周内为其进行择期手术麻醉，但40%的受访者不会。很少有医院针对这个问题制定正式政策，政府指南是基于缺乏不良事件的证据，而非安全的正面证据。
近期接种过疫苗的儿童接受麻醉和手术存在理论风险。一项国际邮政调查未能在儿科麻醉医生中就这种风险达成共识。从风险管理的角度来看，对现有证据的审查表明，在择期手术时间可自由决定的情况下，采取谨慎的方法较为审慎。因此，我们建议儿童在接种非活性疫苗后1周以及接种减毒活疫苗后3周内，应推迟进行择期手术和麻醉。
