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The implications of immunization in the daily practice of pediatric anesthesia

Bertolizio, Gianlucaa; Astuto, Marinellab; Ingelmo, Pabloa

Current Opinion in Anaesthesiology: June 2017 - Volume 30 - Issue 3 - p 368–375
doi: 10.1097/ACO.0000000000000462
PEDIATRIC ANESTHESIA: Edited by Lynne R. Ferrari

Purpose of review Vaccination is an important prevention measure, but requires an intact immune system. Surgery and anesthesia suppress the immune system and may interfere with the benefits of immunization. Moreover, common vaccine side-effects may be misinterpreted as postsurgical complications. This review summarizes the essential basis of immunization and its potential interactions with anesthesia.

Recent findings Vaccines have mild side-effects, such as fever, but may lead to serious complications in immunocompromised patients. Surgery and anesthesia may decrease the efficacy of a vaccine, or promote vaccine-related complications. It, therefore, reasonable to schedule surgery and anesthesia with a delay either before or after vaccine administration, but there is no consensus among anesthesiologists and pediatricians regarding this timing.

Summary Inactive vaccines are generally well tolerated. Live vaccines provide an effective and long-lasting immunization, but may carry more serious complications. Elective operations should be postponed 1 week after an inactive vaccine and 3 weeks after immunization with a live vaccine. To avoid misinterpretation of vaccine-related side-effects, vaccination should be also delayed after surgery.

aDepartment of Anesthesia, McGill University Health Center, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada

bDepartment of Anesthesia and Intensive Care, Catania University Hospital School of Medicine, University of Catania, Catania, Italy

Correspondence to Pablo Ingelmo, MD, Department of Anesthesia, Montreal Children's Hospital, 1001 Boulevard Décarie, Montréal, QC H4A 3J1, Canada. Tel: +1 514 412 4400 24886; e-mail:

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