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Peri-operative respiratory adverse events in children with upper respiratory tract infections allowed to proceed with anaesthesia

A French national cohort study

Michel, Fabrice; Vacher, Thomas; Julien-Marsollier, Florence; Dadure, Christophe; Aubineau, Jean-Vincent; Lejus, Corinne; Sabourdin, Nada; Woodey, Eric; Orliaguet, Gilles; Brasher, Christopher; Dahmani, Souhayl

European Journal of Anaesthesiology (EJA): December 2018 - Volume 35 - Issue 12 - p 919–928
doi: 10.1097/EJA.0000000000000875
Paediatric anaesthesia

BACKGROUND Peri-operative respiratory adverse events (PRAEs) in paediatric patients with upper respiratory tract infections (URTIs) remain inadequately explored in patients allowed to proceed to anaesthesia and surgery.

OBJECTIVE To determine the incidence and risk factors of PRAE in children with URTI allowed to proceed to anaesthesia.

DESIGN Multicentre cohort study performed over 6 months in France.

SETTING Sixteen centres with dedicated paediatric anaesthetists.

PATIENTS Eligible patients were aged from 0 to 18 years with URTI symptoms on admission or a history of such over the preceding 4 weeks.

MAIN OUTCOMES The primary outcome of the study was to determine predictors of PRAE. Secondary outcomes were: predictors of peri-operative arterial desaturation and of the decision to proceed with anaesthesia and surgery in children with URTI.

RESULTS Overall, 621 children were included and 489 (78.7%) anaesthetised. Of those anaesthetised, 165 (33.5%) and 97 (19.8%) experienced PRAE and arterial desaturation, respectively. Factors predictive of PRAE included patient age, tracheal intubation and the absence of midazolam premedication. Factors predictive of peri-operative arterial desaturation included patient age, anaesthetist experience, endoscopic procedures and the presence of other PRAE. Factors predicting proceeding to anaesthesia in the context of URTI included anaesthetist experience, emergency procedures and the absence of severe URTI symptoms.

CONCLUSION The risk of PRAE in patients anaesthetised in the presence of URTI was similar to previous publications – close to 30%. In the light of our findings, first, current rescheduling indications should be questioned, and second, further medical and organisational strategies should be investigated to reduce PRAE in children with URTI.

TRIAL REGISTRATION The study was registered in the European Networks of Centers for Pharmacoepidemiology and Pharmacovigilance (EUPAS16436).

From the Department of Anaesthesia and Intensive care, La TimoneHospital (FM), Espace Ethique Méditerranéen, UMR 7268, Aix-Marseille Université, HôpitalTimone, Marseille Cedex 05 (FM), Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité (TV, FJ-M, SD), Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris (TV, FJ-M, SD), Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital (CD), Institut de Neuroscience de Montpellier, Unité INSERM U1051, Montpellier (CD), Department of Anaesthesia and Intensive Care, Hôtel Dieu Hospital, Nantes (VA, CL), Department of Anaesthesia and Intensive Care, Hôpital Armand Trousseau, Paris (NS), Department of Anaesthesia and Intensive Care, Anne de Bretagne Hospital, Rennes (EW), Department of Anaesthesia and Intensive Care, Necker-Enfant Malades Hospital, Paris, France (GO), Department of Anaesthesia and Pain Management, Royal Children's Hospital (CB), Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia (CB) and DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France (SD)

Correspondence to Souhayl Dahmani, MD, PhD, Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Assistance Publique-des Hôpitaux de Paris, 48 Boulevard Serurier, 75019 Paris, France Tel: +33 1 40 03 41 83; fax: +33 1 40 03 20 00; e-mail:

Published online 17 August 2018

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© 2018 European Society of Anaesthesiology