Elliott Anila B, Jewell Elizabeth, Yuan Yuan, Tremper Kevin, Engoren Milo
C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA.
Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA.
Paediatr Anaesth. 2025 Oct;35(10):856-863. doi: 10.1111/pan.70029. Epub 2025 Aug 4.
Asthma is the most common chronic disease in children. Difficulty in diagnosis can lead to decreased quality of life and increased morbidity and mortality. Children with asthma have increased intraoperative bronchospasm; however, it is unclear whether intraoperative bronchospasm predicts future asthma. We explored intraoperative bronchospasm and subsequent asthma diagnosis.
We retrospectively analyzed 44,284 children aged 2-18 years who underwent non-cardiac surgery under general anesthesia between 2014 and 2020. We collected demographic and peri-operative data, including the occurrence of bronchospasm. We then conducted a subgroup analysis of 35 770 patients that received positive pressure ventilation, using logistic regression to assess the relationship between bronchospasm and airway pressures. The association of bronchospasm and subsequent asthma diagnosis was estimated using generalized estimating equations.
Intraoperative bronchospasm occurred in 128 patients (0.3%) and was associated with increased risk of asthma (OR 2.29, 95% CI 1.10-4.74, p = 0.03). Asthma was diagnosed in 1238 patients (2.8%); 8 had intraoperative bronchospasm (8 of 1238, 0.7%). After adjustment for confounders, male sex (OR 1.57, 95% CI 1.39-1.76, p < 0.001) and younger age (OR 0.96, 95% CI 0.94-0.97, p < 0.001) were also associated with future asthma diagnosis. In the subgroup analysis, Mean PIP (OR 1.50, 95% CI 1.30-1.74, p < 0.001) was associated with asthma.
This study shows intraoperative bronchospasm is associated with an increased risk of future asthma in children. Enhanced collaboration between pediatric anesthesiologists and pediatricians, and further research, is essential to improve asthma detection, risk stratification, and overall care for pediatric patients.
哮喘是儿童最常见的慢性疾病。诊断困难会导致生活质量下降以及发病率和死亡率上升。哮喘患儿术中支气管痉挛的发生率增加；然而，术中支气管痉挛是否可预测未来哮喘尚不清楚。我们探讨了术中支气管痉挛与后续哮喘诊断情况。
我们回顾性分析了2014年至2020年间在全身麻醉下接受非心脏手术的44284例2至18岁儿童。我们收集了人口统计学和围手术期数据，包括支气管痉挛的发生情况。然后，我们对35770例接受正压通气的患者进行了亚组分析，使用逻辑回归评估支气管痉挛与气道压力之间的关系。使用广义估计方程评估支气管痉挛与后续哮喘诊断之间的关联。
128例患者（0.3%）发生术中支气管痉挛，且与哮喘风险增加相关（比值比2.29，95%置信区间1.10 - 4.74，p = 0.03）。1238例患者（2.8%）被诊断为哮喘；8例有术中支气管痉挛（1238例中的8例，0.7%）。在调整混杂因素后，男性（比值比1.57，95%置信区间1.39 - 1.76，p < 0.001）和较年轻年龄（比值比0.96，95%置信区间0.94 - 0.97，p < 0.001）也与未来哮喘诊断相关。在亚组分析中，平均气道峰压（比值比1.50，95%置信区间1.30 - 1.74，p < 0.001）与哮喘相关。
本研究表明，术中支气管痉挛与儿童未来哮喘风险增加相关。儿科麻醉医生与儿科医生加强合作并开展进一步研究，对于改善哮喘检测、风险分层及儿科患者整体护理至关重要。
