Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, WA, Australia.
Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, The Notre Dame University, Fremantle, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia.
Br J Anaesth. 2024 Dec;133(6):1212-1221. doi: 10.1016/j.bja.2024.07.035. Epub 2024 Oct 2.
This review summarises the current evidence for the perioperative preparation in children with upper respiratory tract infections (URTI), including COVID-19 infection. URTI, including COVID-19 infection, are common and frequent in children who present for elective surgery. Children with URTI are at increased risk of perioperative respiratory adverse events. Perioperative respiratory adverse events are among the most serious and impactful consequences of paediatric anaesthesia, including cardiorespiratory arrest, and therefore present a significant challenge for the paediatric anaesthetist. This review addresses the pathophysiology and time course of URTI, including COVID-19. The evidence-based patient, anaesthetic, and surgical risk factors for perioperative respiratory adverse events are summarised. These risk factors work synergistically to determine individual patient risk and allow for risk stratification both clinically and with validated scoring systems. Evidence-based optimisation of modifiable respiratory risk factors can reduce the risk of perioperative bronchospasm. The evidence for the anaesthesia management options, including the timing and setting of surgery, experience of the paediatric anaesthetist, premedication, choice of airway device, choice of agent for induction and maintenance of anaesthesia, and deep vs awake tracheal extubation techniques along with a risk stratification framework are discussed.
这篇综述总结了目前关于上呼吸道感染（URTI）患儿，包括 COVID-19 感染患儿，围手术期准备的证据。URTI，包括 COVID-19 感染，在择期手术的儿童中很常见且频繁。URTI 患儿围手术期发生呼吸不良事件的风险增加。围手术期呼吸不良事件是小儿麻醉中最严重和最具影响力的后果之一，包括心肺骤停，因此对小儿麻醉师提出了重大挑战。本综述讨论了 URTI，包括 COVID-19 的病理生理学和时间过程。总结了围手术期呼吸不良事件的基于证据的患者、麻醉和手术危险因素。这些危险因素协同作用，确定个体患者的风险，并允许通过临床和经过验证的评分系统进行风险分层。优化可改变的呼吸危险因素可以降低围手术期支气管痉挛的风险。讨论了麻醉管理选择的证据，包括手术的时机和地点、小儿麻醉师的经验、术前用药、气道设备的选择、诱导和维持麻醉药物的选择、以及深度与清醒气管拔管技术以及风险分层框架。
