Evidence-based perioperative management of a child with upper respiratory tract infections (URTIs) undergoing elective surgery; A systematic review

Abstract

Background: Upper respiratory tract infections are frequently encountered medical problems in paediatric age groups. Children with less than five years may have six up to seven episodes of URTIs per year with each lasting up to two weeks. The issue of whether to proceed with elective surgery on a child with an URTI has been source of debate for many years. The rationale of this review was to avoid traditional approach of blanket cancellation of surgery by stratified risk factors as well as optimization of the patients. Furthermore, this review summarized current evidences regarding perioperative anaesthetic management of children with URTIs. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find high-level evidences that help to draw appropriate conclusions. Discussion: Performing anaesthesia in children with URTIs increases the risk of perioperative respiratory adverse events (PRAEs) like laryngospasm, bronchospasm, and desaturation and breath holding. Conclusion: Children with mild and moderate URTIs can safely anaesthetized with optimal preparation and optimization of the patient in the preoperative period. Prevention of stimulation of a potentially irritable airway, use of bronchodilators and induction with propofol are helpful. Furthermore, adequate suppression of airway reflexes with optimal depth of anaesthesia is highly recommended.