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Upper Respiratory Tract Infection 

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Background 

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  • Upper respiratory tract infection (URTI) definition is two or more of the following symptoms: rhinorrhoea, sore or scratchy throat, sneezing, nasal congestion, malaise, cough, or fever > 38°C 

  • children under the age of 4 have on average up to 8 URTI per year

  • Between 25%-45% of children presenting for elective surgery will have a history of a recent URTI

  • URTI is the most common cause of surgery cancellation in children

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Considerations 

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  • ↑ Risk of perioperative respiratory adverse events (e.g. laryngospasm, bronchospasm, desaturations, breath holding) up to 2 weeks after a URTI 

  • Risk factors that ↑ this risk further: age <2, prematurity, passive smoking, respiratory comorbidities, airway surgery, and use of ETT 

  • Risk and benefit analysis of proceeding with surgery by considering the severity of the URTI and the urgency of the surgery 

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Management 

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  • Determine whether or not to proceed with surgery 

    • Mild URTI (clear runny nose, dry cough):

      • Proceed with surgery but practice good perioperative pulmonary care 

    • Moderate URTI (green runny nose, mild moist cough):

      • Need to consider risk/benefit ratio for the patient 

      • Factors in favour of proceeding: team experience, institutional setting, previous cancellations and logistics, non-invasive airway management, extended monitoring possible 

      • Factors in favour to cancel: parental concerns, age <1 year and prematurity, respiratory comorbidity, certain viral illnesses such as RSV, airway surgery, ETT required 

    • Severe URTI (green runny nose, severe moist cough, wheezing, fever, lethargy): post-pone and re-evaluate in 2 weeks 

  • Good preoperative pulmonary care: 

    • Experienced paediatric anesthesia team 

    • Less invasive airway device (e.g. LMA) preferred 

    • Consider pre-treatment with inhaled salbutamol 

    • IV induction is preferred 

    • Avoid desflurane 

    • TIVA or propofol bolus prior to airway removal 

    • IV lidocaine may be helpful to reduce the laryngospam reflex

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References 

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  • An update on the perioperative management of children with upper respiratory tract infections.  Current Opinion in Anaesthesiology: June 2017 - Volume 30 - Issue 3 - p 362-367.

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