Perioperative respiratory assessment and management

Perioperative management for childhood asthma

BACKGROUND

Children with asthma have been reported to be at increased risk for intraoperative bronchospasm. Current medical literature focuses on this problem in adult patients. This is a report of our experience in children.

OBJECTIVE

The purpose of this study was to discern whether children with reactive airways disease (asthma) actually had a high likelihood of perioperative bronchospasm as the medical literature suggests.

METHODS

A retrospective chart review of 386 asthmatic children and 51 with bronchopulmonary dysplasia seen perioperatively between 1987 and 1992 was instituted. Children with asthma were classified as mild, moderate or severe based on the number of hospitalizations, emergency room visits, intensive care unit admissions and medications at the time of evaluation. Patients with bronchopulmonary dysplasia were included in a separate category. Individualized asthma management was recommended for all patients in preparation for surgery. Blood gases, chest radiographs and pulmonary function studies were not routinely ordered.

RESULTS

Only 3 of 437 children in a five-year period (0.13%) had intraoperative bronchospasm, easily controlled with the use of beta-2 agonists.

CONCLUSIONS

This study demonstrates that asthmatic children appropriately prepared for surgery do not appear to have an increased risk for adverse outcome. The children treated with more than inhaled beta-2 agonists were those who had more severe asthma, recent viral infection, recent exacerbation of asthma, or recent hospitalization for asthma.