From the Department of Anaesthesia and Intensive care, La TimoneHospital (FM), Espace Ethique Méditerranéen, UMR 7268, Aix-Marseille Université, HôpitalTimone, Marseille Cedex 05 (FM), Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité (TV, FJ-M, SD), Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris (TV, FJ-M, SD), Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital (CD), Institut de Neuroscience de Montpellier, Unité INSERM U1051, Montpellier (CD), Department of Anaesthesia and Intensive Care, Hôtel Dieu Hospital, Nantes (VA, CL), Department of Anaesthesia and Intensive Care, Hôpital Armand Trousseau, Paris (NS), Department of Anaesthesia and Intensive Care, Anne de Bretagne Hospital, Rennes (EW), Department of Anaesthesia and Intensive Care, Necker-Enfant Malades Hospital, Paris, France (GO), Department of Anaesthesia and Pain Management, Royal Children's Hospital (CB), Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia (CB) and DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France (SD).
Eur J Anaesthesiol. 2018 Dec;35(12):919-928. doi: 10.1097/EJA.0000000000000875.
Peri-operative respiratory adverse events (PRAEs) in paediatric patients with upper respiratory tract infections (URTIs) remain inadequately explored in patients allowed to proceed to anaesthesia and surgery.
To determine the incidence and risk factors of PRAE in children with URTI allowed to proceed to anaesthesia.
Multicentre cohort study performed over 6 months in France.
Sixteen centres with dedicated paediatric anaesthetists.
Eligible patients were aged from 0 to 18 years with URTI symptoms on admission or a history of such over the preceding 4 weeks.
The primary outcome of the study was to determine predictors of PRAE. Secondary outcomes were: predictors of peri-operative arterial desaturation and of the decision to proceed with anaesthesia and surgery in children with URTI.
Overall, 621 children were included and 489 (78.7%) anaesthetised. Of those anaesthetised, 165 (33.5%) and 97 (19.8%) experienced PRAE and arterial desaturation, respectively. Factors predictive of PRAE included patient age, tracheal intubation and the absence of midazolam premedication. Factors predictive of peri-operative arterial desaturation included patient age, anaesthetist experience, endoscopic procedures and the presence of other PRAE. Factors predicting proceeding to anaesthesia in the context of URTI included anaesthetist experience, emergency procedures and the absence of severe URTI symptoms.
The risk of PRAE in patients anaesthetised in the presence of URTI was similar to previous publications - close to 30%. In the light of our findings, first, current rescheduling indications should be questioned, and second, further medical and organisational strategies should be investigated to reduce PRAE in children with URTI.
The study was registered in the European Networks of Centers for Pharmacoepidemiology and Pharmacovigilance (EUPAS16436).
在上呼吸道感染（URTI）患儿中，允许进行麻醉和手术的情况下，围手术期呼吸不良事件（PRAE）的研究仍不充分。
确定允许接受麻醉的 URTI 患儿发生 PRAE 的发生率和危险因素。
在法国进行的为期 6 个月的多中心队列研究。
有专门儿科麻醉师的 16 个中心。
符合条件的患者年龄在 0 至 18 岁之间，入院时有 URTI 症状或在过去 4 周内有此类病史。
该研究的主要结果是确定 PRAE 的预测因素。次要结果是：URTI 患儿围手术期动脉血氧饱和度降低的预测因素，以及决定进行麻醉和手术的预测因素。
共有 621 名患儿入选，其中 489 名（78.7%）接受了麻醉。在接受麻醉的患儿中，有 165 名（33.5%）和 97 名（19.8%）发生了 PRAE 和动脉血氧饱和度降低。PRAE 的预测因素包括患者年龄、气管插管和无咪达唑仑术前用药。围手术期动脉血氧饱和度降低的预测因素包括患者年龄、麻醉医生经验、内镜检查和其他 PRAE 的存在。在 URTI 存在的情况下决定进行麻醉的预测因素包括麻醉医生经验、紧急程序和无严重 URTI 症状。
在 URTI 存在的情况下为患儿进行麻醉时，发生 PRAE 的风险与之前的研究相似-接近 30%。根据我们的研究结果，首先，应该质疑当前的重新安排的适应证，其次，应该进一步研究医疗和组织策略，以降低 URTI 患儿的 PRAE。
该研究在欧洲药物流行病学和药物警戒网络（EUPAS16436）中进行了注册。
