It is fairly easy to avoid surgical complications in children related to anesthesia administration by asking a few simple questions before arriving at the operating table. Britta S von Ungern-Sternberg from the Princess Margaret Hospital for Children, Subiaco, Australia, and international colleagues found that a risk evaluation questionnaire isolated and identified breathing side effects related to an aesthesia. Symptoms that contributed to this risk assessment include history of asthma, rhinitis, eczema, and exposure to tobacco smoke according to an article published Online First and in a recent edition of The Lancet.
A complication with the respiratory system’s functionality is one of the main culprits responsible for death in child surgery involving the use of an aesthesia. To date most research centered around a specific youth group or isolated populations in an attempt to identify risk factors in youths. However, Von Ungern-Sternberg’s study shows that a thorough assessment can lead to a more customized anesthetic program and save lives.
Children at high risk for perioperative respiratory adverse events could be systematically identified at the preanaesthetic assessment and thus can benefit from specifically targeted anesthesia management.
A positive, detailed and accurate respiratory history assessment seems a more efficient way of spotting the possibility of adverse respiratory events than The American Society of Anesthesiologists (ASA) physical status system that is currently used to spot potential complications in children undergoing an anesthesia program during surgical procedures.
Jerrold Lerman from the Woman and Children’s Hospital of Buffalo, NY, USA, says:
Today’s study adds an interesting perspective to our understanding of perioperative respiratory adverse events in a cross-section of children undergoing surgery, although its external validity might be challenged and the reproducibility of several findings requires further research…Randomized trials are required to evaluate and validate the contributions of some subpopulations and management strategies to the frequency of perioperative respiratory adverse events.
The Australian study was conducted just under a year, between February 2007 and January 2008 utilizing 9,297 distinct questionnaires. Information was harvested using an adapted version of the International Study Group for Asthma and Allergies Childhood (ISAAC) on the same day of a child’s surgery. Potentially life threatening complications such as bronchospasm and laryngospasm (sudden constriction of bronchial or lung walls) were preempted using three alert systems: 1. A twelve month history that included one or more of the following symptoms: cold, wheezing during exercise, wheezing more than three times in the past 12 months, nocturnal dry cough, eczema. 2. Recent, or within the last two weeks before surgery, signs of an upper respiratory tract infection, eczema, and a history of asthma, atopy, smoking, rhinitis. 3. Eczema (a skin condition) in at least two family members.
In an interesting side note, the study’s authors identified risk higher when children were exposed to maternal smoking or both parents smoking, than when only the father smokes.
Finally, another key factor in fatality prevention was the level of expertise in the administer of an anesthesia treatment plan. For example, a registrar instead of a specialist pediatric anesthetist. There are also factors, both positive and negative, related to inhaled versus IV anesthesia implementation.
Prof Britta S von Ungern-Sternberg PhD, Krisztina Boda PhD, Neil A Chambers MD, Claudia Rebmann MD, Chris Johnson MD, Prof Peter D Sly PhD, Walid Habre PhD
The Lancet, Volume 376, Issue 9743, Pages 773 – 783, 4 September 2010
Written by: Sy Kraft, B.A. – Journalism – California State University, Northridge (CSUN)