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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. CONTROVERSIES. McGill – 1979 CHILDREN – 11 COMPLICATIONS
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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
CONTROVERSIES McGill – 1979 CHILDREN – 11 COMPLICATIONS EASILY DESATURATED 2 TO 7 TIMES MORE COMPLICATIONS (11 TIMES) POSTOPERATIVE INFECTIONS POSTPONEMENT DUE TO URI
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
PATHOPHYSIOLOGICAL CHANGES INFLAMMATION OEDEMA SECRETIONS AIRWAY HYPERREACTIVITY
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 ↑
RISK FACTORS PARNIS PREDICTORS OF ANAESTHETIC COMPLICATIONS: • AIRWAY INSTRUMENT – ETT > LMA > MASK • HISTORY OF COLD • STRONG SNORING • PASSIVE SMOKING • INDUCTION – THIO>HALO>SEVO>PROPOFOL • SPUTUM • NASAL CONGESTION • REVERSAL – NO REVERSAL > REVERSAL
OTHER RISK FACTORS AGE < 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
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
COMPLICATIONS COUGH, BREATH HOLDING, STRIDOR SPASM – BRONCHO / LARYNGO POSTOP. PENUMONIA BRADY / TACHY ARRHYTHMIA POSTOP. INFECTIONS
Surgery urgent Yes No Proceed ? Infectious aetiology Yes No Severe Symptoms Proceed Yes No or Recent URI Postpone 4 wks General Anaesthesia • Alan Tait’s algorithm: 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 ? Proceed Good Poor Management Avoid ETT Use LMA Pulse Oxymetry Hydration Humidification Anticholinergics Postpone for 4 wks
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
"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