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Bronchodilator premedication does not decrease respiratory adverse events in pediatric general anesthesia

[Une prémédication bronchodilatatrice ne réduit pas les événements respiratoires indésirables en anesthésie générale pédiatrique]

Tom Elwood, MD^*, William Morris, MD, Lynn D. Martin, MD^*, Mary-Kay Nespeca, RN^*, David A. Wilson, PhD, Lee A. Fleisher, MD, James L. Robotham, MD FRCA and David G. Nichols, MD

^* From the Departments of Anesthesiology, Children’s Hospital and Regional Medical Center, Seattle, Washington;
Emergency Medicine, University of Washington School of Medicine, Washington;
Anesthesiology, University of Rochester Medical Center, Rochester, New York; and
Anesthesiology and Critical Care Medicine, John Hopkins Hospital, Baltimore, Maryland, USA.

Address correspondence to: Dr. Tom Elwood, Department of Anesthesiology, Children’s Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, Washington 98105, USA. Phone: 206-987-2123; Fax: 206-987-3935; E-mail: tomelwood{at}hotmail.com

Purpose: Upper respiratory infections (URI) presage perioperative respiratory complications, but thresholds to cancel surgery vary widely. We hypothesized that autonomically-mediated complications seen during emergence from anesthesia would be predicted by capnometry and reduced with preoperative bronchodilator administration.

Methods: Afebrile outpatient tertiary-care children (age two months to 18 yr, n = 109) without lung disease or findings, having non-cavitary, non-airway surgery for under three hours, were randomized to bronchodilator premedication vs placebo and had preoperative capnometry. After halothane via mask, laryngeal mask airway, or endotracheal tube, and regional anesthesia as appropriate, patients recovered breathing room air while cough, wheeze, stridor, laryngospasm, and cumulative desaturations were recorded for 15 min.

Results: In this specific population, there was no association between adverse events and either URI within six weeks (n = 76) or URI within seven days (n = 21). Neither albuterol nor ipratropium premedication decreased adverse events. Endotracheal intubation was associated with increased emergence desaturations and placebo nebulized saline increased emergence coughing. Neither anesthesiologists nor preoperative capnometry predicted adverse events.

Conclusions: Adverse events were neither predicted nor prevented. In afebrile outpatient ASA I and II children with no lung disease or findings, having non-cavitary, non-airway surgery for under three hours, there was no association between either recent URI or active URI and desaturation, wheeze, cough, stridor, or laryngospasm causing desaturation (all P > 0.05). In this highly selected population of afebrile patients, the results suggest that anesthesiologists may proceed with surgery using specific criteria in the presence of a URI.

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