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Scientific article
English

Peri-operative adverse respiratory events in children

Contributors

von Ungern-Sternberg, B S; Ramgolam, A; Hall, G L; Sly, P D; Habre, Walid

Published in

Anaesthesia, vol. 70, no. 4, p. 440-444

Publication date

2015

Abstract

Three quarters of all critical incidents and a third of all peri-operative cardiac arrests in paediatric anaesthesia are caused by adverse respiratory events. We screened for risk factors from children's and their families' histories, and assessed the usefulness of common markers of allergic sensitisation of the airway as surrogates for airway inflammation and increased risk for adverse respiratory events. One hundred children aged up to 16 years with two or more risk factors undergoing elective surgery were included in the study. Eosinophil counts, IgE level, specific IgE for D. pteronyssinus, cat epithelia and Gx2 (grass pollen) were measured for each child and adverse respiratory events (bronchospasm, laryngospasm, oxygen desaturation < 95%, severe persistent coughing, airway obstruction and postoperative stridor) were recorded. Twenty-one patients had an adverse respiratory event but allergic markers were poor predictors. Binary logistic regression showed a lack of predictive value of the eosinophil range and adverse respiratory events (p = 0.249). Receiver operating characteristic (ROC) curves for the presence of adverse respiratory events vs level of specific IgE antibody (to Gx2 (AUC 0.614), cat epithelia (0.564) and D. pteronyssinus (0.520)) demonstrated poor predictive values. However, the presence of risk factors was strongly associated with adverse respiratory events (p < 0.001) and a ROC-curve analysis indicated a fair capacity to predict adverse respiratory events (AUC 0.788). There was a significant difference (p = 0.001) between the presence of adverse respiratory events in patients with more than four (p = 0.006), compared with less than four (p = 0.001), risk factors. We conclude that while risk factors taken from the child's (or family) history proved good predictors of adverse respiratory events, immunological markers of allergic sensitisation demonstrated low predictive values. Pre-operative identification of children at high risk for an adverse respiratory event should rely on clinical, rather than immunological, assessment.

Keywords

  • Adolescent
  • Biological Markers/blood
  • Child
  • Child, Preschool
  • Elective Surgical Procedures
  • Eosinophils/pathology
  • Female
  • Humans
  • Hypersensitivity/complications
  • Immunoglobulin E/blood
  • Infant
  • Intraoperative Complications/immunology
  • Leukocyte Count
  • Male
  • Medical History Taking
  • Postoperative Complications/immunology
  • Preoperative Care/methods
  • Respiration Disorders/etiology/immunology
  • Respiratory Tract Infections/complications
  • Risk Assessment/methods
  • Risk Factors

UNIGE affiliation entities

UNIGE research groups

Citation (ISO format)

VON UNGERN-STERNBERG, B S et al. Peri-operative adverse respiratory events in children. In: Anaesthesia, 2015, vol. 70, n° 4, p. 440–444. doi: 10.1111/anae.12946

Main files (1)

Article (Published version)

Identifiers

Journal ISSN

0003-2409
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Technical informations

Creation

06/07/2015 10:10:00

First validation

06/07/2015 10:10:00

Update

14/03/2023 23:27:23

Status update

14/03/2023 23:27:23

Last indexation

31/10/2024 00:48:31
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