Tait URI 2005 - PEDIATRIC ANESTHESIA SOCIETY FOR PEDIATRIC...

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P EDIATRIC A NESTHESIA S OCIETY FOR P EDIATRIC A NESTHESIA S ECTION E DITOR P ETER J. D AVIS R EVIEW A RTICLE Anesthesia for the Child with an Upper Respiratory Tract Infection: Still a Dilemma? Alan R. Tait, PhD , and Shobha Malviya, MD Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor, Michigan One of the most controversial issues in pediatric anes- thesiahasrevolvedaroundthedecisiontoproceedwith anesthesia and surgery for the child who presents with an upper respiratory tract infection (URI). In the past, doctrine dictated that children with URIs have their surgery postponed until the child was symptom free. This practice was based on the empirically supported premise that anesthesia increased the risk of serious complications and complicated the child’s postopera- tive course. Although recent clinical data confirm that some children with URIs are at increased risk of periop- erative complications, these complications can, for the most part, be anticipated, recognized, and treated. Al- though the child with a URI still presents a challenge, anesthesiologists are now in a better position to make informed decisions regarding the assessment and man- agement of these children, such that blanket cancella- tion has now become a thing of the past. (Anesth Analg 2005;100:59–65) T raditionally, children who present for elective surgery with an upper respiratory tract infection (URI) have had their procedure postponed at least until they are asymptomatic. The rationale for this practice was based on empirically derived data suggesting an association between the administration of anesthesia to a child with a URI and the appearance of respiratory complications. More recent scientific data have, in essence, confirmed these observations (1–3) although, for certain pediatric surgical popula- tions, there appears to be no increased risk (4,5). These studies also showed that despite a general increase in the incidence of perioperative respiratory complica- tions in children with URIs, most were manageable with minimal associated morbidity. Despite the importance of this clinical problem, there is still no consensus regarding the optimal anes- thetic management of children with URIs who require elective surgery. Although several studies have ad- dressed this issue, it has been difficult to develop evidence-based practice guidelines given differences in study design, URI criteria, and outcomes. The debate surrounding the decision to cancel or proceed with elective surgery for the patient with a URI is not new. In a 1955 commentary, Ellis (6), while recognizing the potential for complications, made a case for proceeding with surgery despite the presence of a URI: “. . .although anesthesia may not be good treatment for the common cold, might it not be a good way of passing the time till the cold is gone?” Although a few studies had touched on the subject of complications associated with respiratory infec- tions, the primary impetus to cancel surgery for chil-
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This note was uploaded on 12/28/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Tait URI 2005 - PEDIATRIC ANESTHESIA SOCIETY FOR PEDIATRIC...

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