Effect And Risk Factors Assessment Of Mild To Moderate URI On Perioperative Respiratory Complications In Children Underwent Elective Surgery General Anesthesia

Objective:To investigate the effect of combining mild to moderate upper respiratory infection(URI) on perioperative respiratory complications (PRC) in children underwent electivesurgery under general anesthesia.Methods:This study was a prospective, large-scale open clinical study, collecting childrenunderwent elective surgery under general anesthesia who were aged not more than16yearsold, with gradeⅠ-Ⅲ by ASA classification, and permanently resided in the altitude lowerthan2500meters. Patients with the following conditions were excluded: history ofhalogenated anesthetic allergic diseases; significant cardiovascular, respiratory, centralnervous system and history of liver and kidney diseases; recently diagnosed (within2weeks) as severe and lower respiratory infections; oral and respiratory-related surgery.Based on preoperative URI symptoms and signs, the involved patients were divided intoURI group and unURI group. The URI group included children with mild to moderate URIonly involving the nasopharyngeal region, in which the children with severe symptoms andsigns of severe systemic URI were excluded. The unURI group included the childrenwithout URI symptoms or signs. Various data in different periods were monitored andrecorded.①Screening period (1day prior to surgery): The age, weight, nationality, ASAclassification, the name of proposed surgery, history taking, respiratory symptoms andsigns, body temperature, heart rate, respiration, SpO2and laboratory test results were recorded.②Surgical observation period (the day of surgery): The HR, body temperature,SpO2, number of sputum suction and occurrence of respiratory-related complications(excessive phlegm, glossocoma, breath holding, laryngospasm, bronchospasm, SpO2<95%,axillary T≥38℃) were recorded at points in time of children into the operating room,anesthesia induction, the start of intubation, the end of intubation, the start of surgery, theend of surgery, withdrawal, into the postanesthesia care unit (PACU), before extubation,after extubation and out of PACU; the anesthesia time, operation time, intubation time,recovery time, PACU time, estimated volume of blood loss and intraoperative fluid volumewere recorded.③Postoperative observation period: The postoperative6h,24h and48hrespiratory complications and those before discharge, body temperature, HR, respiration,SpO2and laboratory test results were recorded.④Discharge summary recording: Thedischarge diagnosis, actual length of day, total costs and out-of-hospital outcome wererecorded.Results:A total of504cases of children were selected from the preliminarily screened613cases and finally included in this study, in which78children (15.5%) were combined withURI and426children were combined with unURI (84.5%).477cases of patients were inthe anesthesia airway management of endotracheal intubation, in which74cases werecombined with URI (15.5%);27cases of patients were combined with non-intubationanesthesia, in which four cases were combined with URI (14.8%). For URI children withdifferent airway management ways, the difference in the constitution ratio was notstatistically significant between groups (P<0.05).477cases of children underwentscheduled endotracheal intubation under general anesthesia were divided into URI group(n=74) and unURI group (n=403), and the differences in gender, ASA classification,anesthesia time, operation time and surgical site were not statistically significant betweentwo groups (P>0.05); the differences in age and anesthesia induction way were statisticallysignificant between two groups (P<0.05).①The occurrence of PRC in each observationperiod: In the operating room, there were15patients (20.3%) in the URI group and29patients (7.2%) in the unURI group; the incidence rate of PRC in the URI group was2.82times of that in the unURI group (RR2.82,95%CI1.59-4.99)(P<0.001). In the PACU,there were30patients (40.5%) in the URI group and89patients (22.1%) in the unURIgroup; the incidence rate of PRC in the URI group was1.84times of that in the unURI group (RR1.84,95%CI1.32-2.56)(P<0.001). At postoperative6h, there were38patients(51.4%) in the URI group and97patients (24.1%) in the unURI group; the incidence rateof PRC in the URI group was2.13times of that in the unURI group (RR2.13,95%CI1.61-2.83)(P<0.001). At postoperative24h, there were19patients (25.7%) in the URIgroup and42patients (10.4%) in the unURI group; the incidence rate of PRC in the URIgroup was2.46times of that in the unURI group (RR2.46,95%CI1.52-3.99),(P<0.001).At postoperative48h, there were6patients (8.1%) in the URI group and14patients (3.5%)in the unURI group; the difference was not statistically significant between groups(P=0.130).②The variation tendency of PRC at each time period: There were51patients(68.9%) in the URI group and178patients (44.2%) in the unURI group appeared any kindof complication in each time period; the incidence rate of PRC in the URI group was1.56times of that in the unURI group (RR1.56,95%CI1.29-1.88)(P<0.001). There were33patients (44.6%) in the URI group and60patients (14.9%) in the unURI group occurredappeared two or more complications in each time period; the incidence rate of PRC in theURI group was3.0times of that in the unURI group (RR3.00,95%CI2.12-4.23)(P<0.001). Compared with postoperative24h and48h, the incidence rates of postoperative6h PRC were significantly increased between two groups (P<0.05); compared withchildren in the operating room, the incidence rates of PRC in PACU were also significantlyincreased between two groups (P<0.05).③The occurrence of various PRC: The overallincidence rate of cough during the observation period in the URI group was2.28times ofthat in the unURI group (RR2.28,95%CI1.69-3.08); the overall incidence rate ofexcessive sputum in the URI group was2.68times of that in the unURI group (RR2.68,95%CI1.87-3.84); the overall incidence rate of axillary T≥38℃in the URI group was1.62times of that in the unURI group (RR1.62,95%CI1.03-2.53); the overall incidencerate of SpO2<95%in the URI group was2.48times of that in the unURI group (RR2.48,95%CI1.42-4.32)(P<0.05).④The anesthesia-recovery conditions in two groups ofchildren: Compared with the unURI group, the duration from extubation to out of PACU inthe URI group was prolonged (P<0.05); the differences in the duration from withdrawal toextubation and length of stay in PACU were not statistically significant between twogroups (P>0.05).⑤The overall outcomes in two groups of children: Two groups ofchildren were all discharged with doctor’s advices, without any death occurred in children.In addition, the differences in the duration of waiting for surgery (the duration from admission to surgery), postoperative duration of treatment (the duration from surgery todischarge) and length of stay were not statistically significant between two groups(P>0.05).Conclusion:1. The incidence of PRC is higher in children with mild to moderate URI after theimplementation of endotracheal intubation under general anesthesia, which may notseriously affect the recovery time, length of stay and outcome.2. PACU and postoperative6h are the high-risk periods of PRC occurred in childrenwith mild to moderate URI. Taking anesthesia recovery in PACU is a great significance toimprove children perioperative safety. Objective:To investigate the risk factors of perioperative respiratory complications (PRC) inchildren underwent elective endotracheal intubation under general anesthesia.Methods:This study enrolled children underwent elective endotracheal intubation under generalanesthesia who were aged not more than16years old, with gradeⅠ-Ⅲ by ASAclassification, and permanently resided in the altitude lower than2500meters. Patientswith the following conditions were excluded: history of halogenated anesthetic allergicdiseases; significant cardiovascular, respiratory, central nervous system and history of liverand kidney diseases; recently diagnosed (within2weeks) as severe and lower respiratoryinfections; oral and respiratory-related surgery. Various data in different periods weremonitored and recorded.①Screening period (1day prior to surgery): The age, weight,nationality, ASA classification, the name of proposed surgery, history taking, respiratorysymptoms and signs, body temperature, heart rate, respiration, SpO2and laboratory testresults were recorded.②Surgical observation period (the day of surgery): The HR, bodytemperature, SpO2, number of sputum suction and occurrence of respiratory-relatedcomplications (excessive phlegm, glossocoma, breath holding, laryngospasm,bronchospasm, SpO2<95%, axillary T≥38℃) were recorded at points in time of childreninto the operating room, anesthesia induction, the start of intubation, the end of intubation,the start of surgery, the end of surgery, withdrawal, into the postanesthesia care unit(PACU), before extubation, after extubation and out of PACU; the anesthesia time,operation time, intubation time, recovery time, PACU time, estimated volume of blood lossand intraoperative fluid volume were recorded.③Postoperative observation period: Thepostoperative6h,24h and48h respiratory complications and those before discharge, bodytemperature, HR, respiration, SpO2and laboratory test results were recorded.④Discharge summary recording: The discharge diagnosis, actual length of day, total costs and out-of-hospital outcome were recorded.In univariate analysis, the occurrence of not less than two kinds of perioperativerespiratory complications was considered as dependent variables; age, gender, nationality,surgical season, URI degree, ASA classification, surgical site, surgical time, anesthesiainduction way, number of intubation, anesthesia time, duration from withdrawal toextubation, duration from extubation to out of PACU, length of stay in PACU, duration ofwaiting for surgery, postoperative duration of treatment and length of stay were consideredas categorical variables. For categorical variables, the chi-square test was used to evaluaterisk factors of respiratory complications.In multivariate analysis, the categorical variables of P<0.05in univariate analysis wereconsidered as concomitant variables for establishment of multivariate Logistic regressionanalysis model; the occurrence of not less than two kinds of perioperative respiratorycomplications was considered as dependent variables; P≤0.05was considered as thestandard of stepwise regression for screening variables; the independent factors of theoccurrence of not less than two kinds of PRC were analyzed.The URI degree was divided into mild URI (miURI), moderate URI (moURI) andunURI. miURI only involved nasal symptoms of nasal congestion, rhinorrhoea, sneezingand tussicula; moURI involved the nasopharyngeal region, with expectoration,pharyngalgia, hyperhidrosis, headache, fatigue, degreeⅠ-Ⅱ of antiadoncus, pharyngealhyperemia, and fever from37.3℃to38.0℃; unURI was without any sign or symptom.Results:1. Univariate analysis showed that age (P=0.002), season (P=0.000), URI degree(P=0.000), ASA classification (P=0.000), surgical site (P=0.023), operative time (P=0.009),anesthesia induction way (P=0.007), length of stay in PACU (P=0.022), the duration ofwaiting time (P=0.001), length of stay (P=0.013) might be the influencing factors of theoccurrence of not less than two kinds of PRC. The influences of gender, ethnicity, numberof intubation, anesthesia time, duration from withdrawal to extubation, duration fromextubation to out of PACU and postoperative treatment time on the occurrence of not lessthan two kinds of PRC were not statistically significant (P<0.05).2. Logistic regression analysis showed that age, season, URI degree and surgical sitewere independent factors of the occurrence not less than two kinds of PRC, in which agenot more than one year, winter, combined with moderate URI and surgical site likely to seriously affect the respiratory ventilation would lead to increased incidence rates of notless than two kinds of PRC to2.4,3.0,5.9and3.6times.Conclusion:1. For children with ages more than one year, underwent surgery in summer, combinedwith mild URI, and with surgical sites not affecting the respiratory ventilation, it isrelatively safe to carry out the elective surgery underwent general anesthesia.2. For children with ages≤1year, underwent surgery in winter, combined withmoderate URI, and with surgical sites affecting the respiratory ventilation, it issignificantly carefully carried out after weighing the pros and cons，and try to delay theelective surgery.