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 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.

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