URI AND ANAESTHESIAURI AND ANAESTHESIA

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

CONTROVERSIESCONTROVERSIES

McGill – 1979 CHILDREN – 11 COMPLICATIONSMcGill – 1979 CHILDREN – 11 COMPLICATIONS

EASILY DESATURATEDEASILY DESATURATED

2 TO 7 TIMES MORE COMPLICATIONS (11 TIMES)2 TO 7 TIMES MORE COMPLICATIONS (11 TIMES)

POSTOPERATIVE INFECTIONSPOSTOPERATIVE INFECTIONS

POSTPONEMENT DUE TO URI POSTPONEMENT DUE TO URI

INCIDENCE & CAUSATIVE INCIDENCE & CAUSATIVE ORGANISMSORGANISMS

500 MILLION OP, 2 MILLION IP, 8 MILLION 500 MILLION OP, 2 MILLION IP, 8 MILLION DAYS, 2 BILLION DAYS, 2 BILLION $$

INCIDENCE MORE FREQUENT IN CHILDRENINCIDENCE MORE FREQUENT IN CHILDREN

RHINO, INFLUENZA, PARAINFLUENZA, RHINO, INFLUENZA, PARAINFLUENZA, HERPESHERPES

TO BE DIFFERENTIATED FROM SERIOUS TO BE DIFFERENTIATED FROM SERIOUS ILLNESSESILLNESSES

PATHOPHYSIOLOGICAL CHANGESPATHOPHYSIOLOGICAL CHANGES

INFLAMMATIONINFLAMMATION

OEDEMAOEDEMA

SECRETIONSSECRETIONS

AIRWAY HYPERREACTIVITYAIRWAY HYPERREACTIVITY

AIRWAY REACTIVITY & PFTAIRWAY REACTIVITY & PFT

INFLAMMATORY MEDIATORS:INFLAMMATORY MEDIATORS:

BRADYKININ, PROSTAGLANDIN, HISTAMINE, BRADYKININ, PROSTAGLANDIN, HISTAMINE, INTERLEUKININTERLEUKIN

VAGAL AUTONOMIC REFLEXVAGAL AUTONOMIC REFLEX

VIRAL NEURAMINIDASE - VIRAL NEURAMINIDASE - ↑ AC.CHOLINE – MUSCARINIC ↑ AC.CHOLINE – MUSCARINIC RECEPTORSRECEPTORS

↓ ↓ NEUTRAL ENDOPEPTIDASE - ↑ TACHYCHININSNEUTRAL ENDOPEPTIDASE - ↑ TACHYCHININS

LARYNGO / BRONCHOSPASM – 4 TO 6 WKSLARYNGO / BRONCHOSPASM – 4 TO 6 WKS – – 7-FOLD ↑7-FOLD ↑

WORSENED BY GA – RELIEVED BY IPPVWORSENED BY GA – RELIEVED BY IPPV

FEV1, FVC, VC ↓ - RESISTANCE ↑FEV1, FVC, VC ↓ - RESISTANCE ↑

RISK FACTORSRISK FACTORS

PARNIS PREDICTORS OF ANAESTHETICPARNIS PREDICTORS OF ANAESTHETIC

COMPLICATIONS:COMPLICATIONS:1.1. AIRWAY INSTRUMENT – ETT > LMA > MASKAIRWAY INSTRUMENT – ETT > LMA > MASK

2.2. HISTORY OF COLDHISTORY OF COLD

3.3. STRONG SNORINGSTRONG SNORING

4.4. PASSIVE SMOKINGPASSIVE SMOKING

5.5. INDUCTION – THIO>HALO>SEVO>PROPOFOLINDUCTION – THIO>HALO>SEVO>PROPOFOL

6.6. SPUTUMSPUTUM

7.7. NASAL CONGESTIONNASAL CONGESTION

8.8. REVERSAL – NO REVERSAL > REVERSALREVERSAL – NO REVERSAL > REVERSAL

OTHER RISK FACTORSOTHER RISK FACTORS

AGE < 5 YRS / PREMATURITY / AGE < 5 YRS / PREMATURITY /

H/O REACTIVE AIRWAY DISEASEH/O REACTIVE AIRWAY DISEASE

AIRWAY SURGERIESAIRWAY SURGERIES

MALVIYA – OF 1078 CHILDRENMALVIYA – OF 1078 CHILDREN

2 PNEUMONIAS2 PNEUMONIAS

1 STRIDOR in the postop. Period1 STRIDOR in the postop. Period

TWO DEATHS REPORTED –TWO DEATHS REPORTED –

EXTUBATION BRONCHOSPASMEXTUBATION BRONCHOSPASM

CARDIAC ARREST CARDIAC ARREST

ANAESTHETIC MANAGEMENTANAESTHETIC MANAGEMENT

LIDOCAINE NEBULISATIONLIDOCAINE NEBULISATION

HYDRATION / HUMIDIFICATION / SUCTIONINGHYDRATION / HUMIDIFICATION / SUCTIONING

HALOTHANE / SEVOFLURANEHALOTHANE / SEVOFLURANE

MILD CASES – AVOID INTUBATIONMILD CASES – AVOID INTUBATION

SEVERE SYMPTOMS – POSTPONE FOR 6 WKSSEVERE SYMPTOMS – POSTPONE FOR 6 WKS

EMERGENCY – USE LMAEMERGENCY – USE LMA

IF ET REQUIRED – ATROPINE, SALBUTAMOLIF ET REQUIRED – ATROPINE, SALBUTAMOL

AWAKE EXTUBATION, AVOID DEPRESSANTSAWAKE EXTUBATION, AVOID DEPRESSANTS

COMPLICATIONSCOMPLICATIONS

COUGH, BREATH HOLDING, STRIDORCOUGH, BREATH HOLDING, STRIDOR

SPASM – BRONCHO / LARYNGOSPASM – BRONCHO / LARYNGO

POSTOP. PENUMONIAPOSTOP. PENUMONIA

BRADY / TACHY ARRHYTHMIABRADY / TACHY ARRHYTHMIA

POSTOP. INFECTIONSPOSTOP. INFECTIONS

• Alan Tait’s algorithm:Alan Tait’s algorithm:• • • • • • • •

• •

• • •

Surgery urgentSurgery urgent

ProceedProceed YesYes NoNo

? Infectious aetiology? Infectious aetiology NoNo

ProceedProceedYesYes

Severe SymptomsSevere Symptoms

YesYes No or Recent URINo or Recent URI Postpone 4 wksPostpone 4 wks

General AnaesthesiaGeneral Anaesthesia

NoNo

ProceedProceed

YesYesRisk Factors ?Risk Factors ?H/O asthmaH/O asthma Use of ETTUse of ETTCopious secretionsCopious secretionsNasal congestionNasal congestion• Parental SmokingParental SmokingSurgery of airwaySurgery of airwayH/O PrematurityH/O Prematurity

Other FactorsOther FactorsNeed for ExperienceNeed for ExperienceTravelled farTravelled farSurgery cancelled priorSurgery cancelled prior

Risk / Benefit ?Risk / Benefit ?

GoodGood ProceedProceed PoorPoor

Postpone for 4 wksPostpone for 4 wksManagementManagement Avoid ETTAvoid ETT Use LMAUse LMA Pulse OxymetryPulse Oxymetry HydrationHydration HumidificationHumidification AnticholinergicsAnticholinergics

TO SUMMARISETO SUMMARISE

RECOMBINANT NEUTRAL ENDOPEPTIDASERECOMBINANT NEUTRAL ENDOPEPTIDASE

ANTI VIRAL AGENTSANTI VIRAL AGENTS

SPECIFIC M3 BLOCKERSPECIFIC M3 BLOCKER

POSTPONEMENT – INDIVIDUALISEDPOSTPONEMENT – INDIVIDUALISED

KNOWLEDGE OF THE COMPLICATIONS &KNOWLEDGE OF THE COMPLICATIONS &

MANAGEMENTMANAGEMENT

2000 SURGERIES TO BE CANCELLED TO 2000 SURGERIES TO BE CANCELLED TO PREVENT 15 SPASMSPREVENT 15 SPASMS

"Common sense dictates that a patient with an "Common sense dictates that a patient with an active but self limited disease not be subject to active but self limited disease not be subject to elective anaesthesia and surgery until resolution elective anaesthesia and surgery until resolution of the illness". – Statement by McGill in 1979.of the illness". – Statement by McGill in 1979.

“…“…although anesthesia may not be good treatment although anesthesia may not be good treatment for the common cold, might it not be a good way for the common cold, might it not be a good way of passing the time till the cold is gone?” - Ellisof passing the time till the cold is gone?” - Ellis