Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery.
BACKGROUND
Adverse respiratory events remain one of the major causes of morbidity during anaesthesia, especially in children. The purpose of this prospective study was to determine the incidence of perioperative respiratory adverse events (PRAE) during elective paediatric surgery and to identify the risk factors for these events.


METHODS
Potential risk factors (atopy, eczema, rhinitis, food allergy, previous allergic tests, pollens or animal allergy, passive smoking, obstructive sleep disorders) were assessed using the International Society on Allergy and Asthma (ISAAC) questionnaire, which was submitted to the parents during preoperative anaesthetic assessment. Anaesthetic and surgical conditions were systematically recorded. A multivariate logistic regression explaining PRAE was developed in 800 children.


RESULTS
The intraoperative incidence of respiratory adverse events was 21% and the incidence in the postanesthetic care unit was 13%. According to the multivariate analysis, children not anaesthetized by a specialist paediatric anaesthesiologist have 1.7 increased risk to present PRAE (95% CI = 1.13-2.57). Children anaesthetized for ear, nose, throat (ENT) surgery had a 1.57-fold higher risk of PRAE compared with other procedures (95% CI = 1.01-2.44). Furthermore, there was a synergistic interaction when two risk factors: residents and ENT surgery, were concomitant: the odds ratio (OR) of PRAE during non-ENT surgical procedures was 1.43 (95% CI = 0.91-2.24), but increased to 2.74-fold (95% CI = 1.15-4.32) for ENT surgery. The risk of PRAE was significantly lower when the anaesthetic technique included tracheal intubation with relaxants (OR = 0.6, 95% CI = 0.45-0.95) and decreased by 8% with each increasing year of age.


CONCLUSIONS
This study demonstrates a high incidence of PRAE in paediatric surgical patients without respiratory tract infections, which appears to be primarily determined by the age of the child and the anaesthetic care rather than by the child's medical history.
Paediatric Anaesthesia Unit, Division of Anesthesia, University Hospital of Geneva, Geneva, Switzerland. chantal.mamie@hcuge.ch
Chantal
C
Mamie
Walid
W
Habre
Cécile
C
Delhumeau
Constance Barazzone
CB
Argiroffo
Alfredo
A
Morabia
D000402:Airway Obstruction / Q000209:etiology; D000758:Anesthesia / Q000009:adverse effects; D001986:Bronchial Spasm / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D007826:Laryngismus / Q000209:etiology; D008297:Male; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology*; D012307:Risk Factors
D010100:Oxygen