Risk Factors for Respiratory Adverse Events during General Anesthesia in Children

Respiratory adverse events are not rare in pediatric anesthesia. The risk of airway complications must be considered before anesthesia. The current study was designed to determine the incidence and risk factors for adverse respiratory events in children undergoing general anesthesia. The study population included 682 children from neonates to 14 years who were presented for an elective or emergency surgical procedure. Data regarding the incidence and severity of perioperative respiratory complications were collected prospectively. Airway complications occurred in 39/682 cases (5.71%). Laryngeal inspiratory stridor (15/682) and irregular breathing (breath-holding) (10/682) were predominant complications (64.1%). Complete laryngeal spasm, coughing, hiccups and apnea were observed in 3 cases each. Obstruction by the tongue and excessive secretion happened in one child separately. Characteristics associated with an increased frequency of complications included age less than 1 year and existence of a respiratory infection. Most of these complications occurred at emergence from anesthesia (19/39, 48.72%) The face mask group exhibited lower incidence of airway complications than intubated group. There is no significant difference between groups of patients extubated awake and in deep inhalation anesthesia. Respiratory complications appeared almost two times more frequently during emergency than during elective procedures. Age less than 1 year, recent respiratory infection, intubation and emergency procedure were identified as independent factors associated with an increased risk of airway complications during the general anesthesia in children.