URI AND ANAESTHESIA

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URI AND ANAESTHESIA

• DR.S.SUBBIAH., MNAMS., DA., MD., DCH.,
• SENIOR CONSULTANT IN ANAESTHESIOLOGY,
• APOLLO SPECIALITY HOSPITALS, MADURAI,
• FORMER PROFESSOR AND HEAD
• DEAPRTMENT OF ANAESTHESIOLOGY,
• MADURAI MEDICAL COLLEGE, MADURAI

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CONTROVERSIES

• McGill 1979 CHILDREN 11 COMPLICATIONS
• EASILY DESATURATED
• 2 TO 7 TIMES MORE COMPLICATIONS (11 TIMES)
• POSTOPERATIVE INFECTIONS
• POSTPONEMENT DUE TO URI

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INCIDENCE CAUSATIVE ORGANISMS

• 500 MILLION OP, 2 MILLION IP, 8 MILLION DAYS, 2
  BILLION
• INCIDENCE MORE FREQUENT IN CHILDREN
• RHINO, INFLUENZA, PARAINFLUENZA, HERPES
• TO BE DIFFERENTIATED FROM SERIOUS ILLNESSES

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PATHOPHYSIOLOGICAL CHANGES

• INFLAMMATION
• OEDEMA
• SECRETIONS
• AIRWAY HYPERREACTIVITY

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AIRWAY REACTIVITY PFT

• INFLAMMATORY MEDIATORS
• BRADYKININ, PROSTAGLANDIN, HISTAMINE,
  INTERLEUKIN
• VAGAL AUTONOMIC REFLEX
• VIRAL NEURAMINIDASE - ? AC.CHOLINE MUSCARINIC
  RECEPTORS
• ? NEUTRAL ENDOPEPTIDASE - ? TACHYCHININS
• LARYNGO / BRONCHOSPASM 4 TO 6 WKS 7-FOLD ?
• WORSENED BY GA RELIEVED BY IPPV
• FEV1, FVC, VC ? - RESISTANCE ?

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RISK FACTORS

• PARNIS PREDICTORS OF ANAESTHETIC
• COMPLICATIONS
• AIRWAY INSTRUMENT ETT gt LMA gt MASK
• HISTORY OF COLD
• STRONG SNORING
• PASSIVE SMOKING
• INDUCTION THIOgtHALOgtSEVOgtPROPOFOL
• SPUTUM
• NASAL CONGESTION
• REVERSAL NO REVERSAL gt REVERSAL

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• OTHER RISK FACTORS
• AGE lt 5 YRS / PREMATURITY /
• H/O REACTIVE AIRWAY DISEASE
• AIRWAY SURGERIES
• MALVIYA OF 1078 CHILDREN
• 2 PNEUMONIAS
• 1 STRIDOR in the postop. Period
• TWO DEATHS REPORTED
• EXTUBATION BRONCHOSPASM
• CARDIAC ARREST

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ANAESTHETIC MANAGEMENT

• LIDOCAINE NEBULISATION
• HYDRATION / HUMIDIFICATION / SUCTIONING
• HALOTHANE / SEVOFLURANE
• MILD CASES AVOID INTUBATION
• SEVERE SYMPTOMS POSTPONE FOR 6 WKS
• EMERGENCY USE LMA
• IF ET REQUIRED ATROPINE, SALBUTAMOL
• AWAKE EXTUBATION, AVOID DEPRESSANTS

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COMPLICATIONS

• COUGH, BREATH HOLDING, STRIDOR
• SPASM BRONCHO / LARYNGO
• POSTOP. PENUMONIA
• BRADY / TACHY ARRHYTHMIA
• POSTOP. INFECTIONS

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• Alan Taits algorithm
• 
  
• 
  
  
• 
  

Surgery urgent
Yes
No
Proceed
? Infectious aetiology
Yes
No
Proceed
Severe Symptoms
Yes
No or Recent URI
Postpone 4 wks
General Anaesthesia
Yes
No

• Risk Factors ?
• H/O asthma
• Use of ETT
• Copious secretions
• Nasal congestion
• Parental Smoking
• Surgery of airway
• H/O Prematurity

Other Factors Need for Experience Travelled
far Surgery cancelled prior
Proceed
Risk / Benefit ?
Good
Proceed
Poor
Management Avoid ETT Use LMA
Pulse Oxymetry Hydration
Humidification Anticholinergics
Postpone for 4 wks
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TO SUMMARISE

• RECOMBINANT NEUTRAL ENDOPEPTIDASE
• ANTI VIRAL AGENTS
• SPECIFIC M3 BLOCKER
• POSTPONEMENT INDIVIDUALISED
• KNOWLEDGE OF THE COMPLICATIONS
• MANAGEMENT
• 2000 SURGERIES TO BE CANCELLED TO PREVENT 15
  SPASMS

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• "Common sense dictates that a patient with an
  active but self limited disease not be subject to
  elective anaesthesia and surgery until resolution
  of the illness". Statement by McGill in 1979.
• although anesthesia may not be good treatment
  for the common cold, might it not be a good way
  of passing the time till the cold is gone? -
  Ellis

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THANKS