The Star Malaysia
Knocking out a child with a cold
AN upper respiratory tract infection or a cold is the most common health problem encountered during childhood.
Almost 95% of upper respiratory tract infections are caused by viruses – over 200 types, although almost one-third are caused by rhinoviruses alone.
Symptoms include cough, sore throat, nasal discharge or congestion (runny nose), sneezing and fever.
This can be an issue when an infected child requires surgery, whether elective, like circumsion or herniotomy, or emergency procedures such as in accidents or cancer.
It is not uncommon to have elective surgeries for these children postponed by the anaesthetist due to safety reasons.
This is as upper respiratory tract infections are frequently associated with increased anaesthetic risks of adverse respiratory complications such as bronchospasm (constriction of the airways in lung), laryngospasm (constriction of the larynx), breath-holding, airway obstruction that can lead to hypoxia (low oxygen in the blood), bradycardia (low heart rate), and even cardiac arrest.
Upper respiratory tract infections can be either mild or severe.
Those with mild infections appear otherwise healthy, have clear nasal discharge, clear lung sounds (on the stethoscope) and no fever.
In contrast, severe infections come with fever that usually exceeds 38°C, thick and purulent (yellow or green) nasal discharge, cough with sputum, and an obviously ill child.
A chest x-ray may be considered if the medical history and physical examination suggest signs of lower respiratory tract infection.
Most children with mild upper respiratory tract infection going for minor surgery can be safely given anaesthesia without adverse complications.
The risk of adverse side effects during anaesthesia is greatest in the presence of active infection, but there is still increased risk two to four weeks after the symptoms have disappeared.
Children with active or recent upper respiratory tract infection have more significant episodes of breath-holding, severe coughing and low oxygen in blood, compared with uninfected children.
It is of paramount importance that parents inform the anaesthetist of any active or recent upper respiratory tract infection their child may have had before any surgery, as this will influence the anaesthetic plan.
In addition to an upper respiratory tract infection, risk factors like parental smoking, intubation, prematurity, age less than one year old, a history of asthma or snoring, airway surgery and nasal congestion, also increase the chances of adverse anaesthetic complications during surgery.
In my opinion, anaesthetic management for children with upper respiratory tract infections going for surgery requires the consideration of various factors.
These include the child’s age, severity of the symptoms, type and urgency of the surgery, the child’s underlying condition, and the anaesthetist’s experience and comfort in dealing with children who have an upper respiratory tract infection.
In conclusion, anaesthetic management of children with upper respiratory tract infections is challenging and should be managed on a case-by-case basis.
Good clinical judgement, awareness of the risk factors and informed consent from parents are crucial in making the administration of anaesthesia safe for children.
Dr Sivaraj Chandran is a paediatric anaesthetist at Hospital Tengku Ampuan Afzan, Kuantan, Pahang. For more information, email email@example.com. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.